Mannitol as adjunct therapy for childhood cerebral malaria in Uganda: a randomized clinical trial.
BACKGROUND
Several reports have suggested that raised intracranial pressure (ICP) is a major contributor to death among children with cerebral malaria. Mannitol, an osmotic diuretic, effectively lowers ICP and is used to treat post-traumatic raised ICP. It is not clear whether intravenous mannitol given to children with cerebral malaria improves clinical outcome. The objective of this study was to determine the effect of mannitol as adjunct therapy on the clinical outcome of children with cerebral malaria.


METHODS
This randomized double-blind placebo controlled clinical trial was carried out at the Emergency Paediatric ward of Mulago Hospital, Uganda's national referral and teaching hospital. One hundred and fifty six children aged 6 to 60 months with cerebral malaria were randomized to either one dose of mannitol 1 g/kg or placebo, in addition to intravenous quinine. Main outcome measures included coma recovery time; time to sit unsupported, begin oral intake; duration of hospitalization; death and adverse effects.


RESULTS
Time to regain consciousness (p = 0.11), sit unsupported (p = 0.81), time to start oral intake (p = 0.13) and total coma duration (p = 0.07) were similar in both groups. There was no significant difference in the mortality between the placebo (13/80 or 16.3%) and mannitol (10/76 or 13.2%) groups: RR = 1.2 (CI 0.5-2.7). No adverse effects were observed after administration of mannitol.


CONCLUSIONS
Mannitol had no significant impact on clinical outcome of cerebral malaria. It is difficult to recommend intravenous mannitol as adjunct therapy for childhood cerebral malaria.
Namutangula
Beatrice
B
Department of Paediatrics and Child Health, Makerere University Medical School, P O Box 7072 Kampala Uganda. wabwire74@yahoo.com
Ndeezi
Grace
G
Byarugaba
Justus S
JS
Tumwine
James K
JK
D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D002675:Child, Preschool; D004311:Double-Blind Method; D006801:Humans; D007223:Infant; D016779:Malaria, Cerebral / Q000188:drug therapy* / Q000401:mortality*; D008353:Mannitol / Q000627:therapeutic use*; D016896:Treatment Outcome; D014454:Uganda
D000962:Antimalarials; D008353:Mannitol