Background: Quinine and artemisinin drugs are used in severe malaria, but quinine resistance is increasing. Arteether is a recently developed artemisinin derivative that is oil soluble, has a long elimination half life, and is more stable than other derivatives. Objectives: To compare intramuscular arteether with other antimalarial drugs to treat severe malaria. Selection criteria: Randomized and quasi-randomized controlled trials of intramuscular arteether in adults and children with severe malaria. Main results: Two small trials (n=194) met the inclusion criteria. Both trials compared arteether with quinine in children with cerebral malaria and reported on similar outcomes. There was no statistically significant difference in the number of deaths (relative risk 0.75, 95% confidence interval 0.43 to 1.30; n = 194, 2 trials), neurological complications (relative risk 1.18, 95% confidence interval 0.31 to 4.46; n = 58, 1 trial), or other outcomes including time to regain consciousness, parasite clearance time, and fever clearance time. The meta-analyses lack statistical power to detect important differences. Conclusions: More trials with a larger number of participants are needed before a firm conclusion about the efficacy and safety of arteether can be reached.
The Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004391. DOI: 10.1002/14651858.CD004391.pub2.