Academic journal article Bulletin of the World Health Organization

Artemisinin Derivatives versus Quinine for Cerebral Malaria in African Children: A Systematic review/Efficacite Comparee De Derives De L'artemisinine et De la Quinine Contre le Paludisme Cerebral Chez Les Enfants Africains : Revue systematique/Revision Sistematica De Comparacion De Los Derivados De la Artemisinina Y la Quinina Como Tratamientos De la Malaria Cerebral En Ninos Africanos

Academic journal article Bulletin of the World Health Organization

Artemisinin Derivatives versus Quinine for Cerebral Malaria in African Children: A Systematic review/Efficacite Comparee De Derives De L'artemisinine et De la Quinine Contre le Paludisme Cerebral Chez Les Enfants Africains : Revue systematique/Revision Sistematica De Comparacion De Los Derivados De la Artemisinina Y la Quinina Como Tratamientos De la Malaria Cerebral En Ninos Africanos

Article excerpt

Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol.

Introduction

Malaria causes more than one million deaths worldwide each year, and over 90% of them occur in Africa. (1) Plasmodium falciparum causes the most serious form of the disease. (2) Cerebral malaria, which is the most life-threatening complication of P. falciparum malaria, is characterised by unrousable coma not attributable to any other cause. (2) Even with correct treatment, the lethality rate among children with cerebral malaria approaches 20%. (3)

The recommended treatment for cerebral malaria is quinine by slow intravenous infusion. (4) However, quinine has several drawbacks, including a short half-life, painful local reactions after intramuscular and intravenous administration (5) and neurotoxicity. (5,6) Permanent blindness with standard doses of quinine has been well documented. (6) Furthermore, decreasing sensitivity to quinine has been reported in south-eastern Asia and the Amazon region, (7) as well as in parts of Africa. (8)

Artemisinin derivatives, a relatively new group of antimalarials that produce a very rapid therapeutic response and are effective against multidrugresistant P. falciparum, have been used increasingly over the past decade. (9) Although resistance to artimisinin derivatives has been reported along the Thai-Cambodian border, (10) it has not been detected anywhere else. (9) The neurotoxic effects of artemisinin derivatives have been observed in pre-clinical animal studies at doses about 10 times higher than those used for human treatment, (11) but no such toxic effects have been reported in humans. (12)

One Cochrane systematic review has compared arteether with quinine for the treatment of children with cerebral malaria, and another meta-analysis has compared artemether with quinine in adults and children with severe P. falciparum malaria. In the first study, no statistically significant difference was found in the number of deaths or other outcomes, such as coma recovery time, parasite clearance time and fever clearance time. (13) However, in the second study the combined adverse outcome of either death or neurological sequelae was significantly less common in the artemether group. (12)

After the meta-analysis mentioned above, new clinical trials in which artemether has been compared with quinine for the treatment of cerebral malaria in children have been carried out. Although P. falciparum malaria is linked to high mortality in children and cerebral malaria is its most life threatening complication, very few systematic reviews on the treatment of children with cerebral malaria have been performed. Previous systematic reviews have compared either artemether or arteether with quinine, yet it makes sense to summarize their efficacy in a single review because both drugs are oil soluble artemisinin derivatives. If these drugs are as efficacious as quinine in preventing death in children, they are preferable to quinine for the following reasons: (i) their side-effects are fewer and (ii) the Thai-Cambodian border is the only place where resistance to them has been reported, whereas resistance to quinine has been observed in several parts of the world.

The objective of this review is to summarize the existing evidence surrounding the efficacy of artemisinin derivatives (artemether and arteether) versus quinine for the treatment of cerebral malaria in children. It will address the following question. "How efficacious are artemisinin derivatives compared with quinine for the treatment of cerebral malaria in children?"

Methods

Search strategy

We searched the following databases exclusively for randomized controlled trials (RCTs): Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2008); MEDLINE (1966 to May 2008) and EMBASE (1980 to May 2008). …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.