Artemisinin derivatives versus quinine for cerebral malaria in African children: a systematic review.
OBJECTIVE
To summarize the existing evidence on the efficacy of artemether and arteether, two artemisinin derivatives, versus quinine for treating cerebral malaria in children.


METHODS
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and the http://clinicaltrials.gov web site. We also checked the reference lists of existing systematic reviews and of all trials identified by the above methods. We searched exclusively for randomized controlled trials (RCTs) comparing artemether/arteether with quinine for treating cerebral malaria in children. Two independent reviewers assessed study eligibility and trial quality and extracted the data.


RESULTS
Nine RCTs were included in the analysis, and all were from Africa. Five had adequate allocation concealment. Seven trials compared artemether with quinine (1220 children), and two compared arteether with quinine (194 children). No statistically significant difference was found between artemisinin derivatives and quinine in preventing mortality (relative risk, RR: 0.91; 95% confidence interval, CI: 0.73-1.14; I(2): 0%). The quality of the evidence, as assessed by the Grade evidence profile, was moderate. The only serious adverse event was seen in a patient in the quinine group who developed fatal black water fever.


CONCLUSIONS
Artemisinin derivatives are not inferior to quinine in preventing death in children with cerebral malaria.
Kyu
Hmwe Hmwe
HH
McMaster University, Hamilton, ON, L8N 3Z5, Canada. kyuhh@mcmaster.ca
Fernández
Eduardo
E
D000349:Africa; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use*; D037621:Artemisinins / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D007223:Infant; D016779:Malaria, Cerebral / Q000188:drug therapy*; D008297:Male; D017063:Outcome Assessment, Health Care; D011803:Quinine / Q000494:pharmacology / Q000627:therapeutic use*
D000890:Anti-Infective Agents; D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin; D011803:Quinine
Am J Trop Med Hyg. 1997 Jul;57(1):20-4
9242312
Trans R Soc Trop Med Hyg. 2001 Nov-Dec;95(6):637-50
11816438
Wkly Epidemiol Rec. 2007 Oct 12;82(41):360
17933087
BMC Med Res Methodol. 2005 Apr 20;5:13
15840177
Trans R Soc Trop Med Hyg. 1996 May-Jun;90(3):298-301
8758084
J Egypt Soc Parasitol. 2002 Aug;32(2):611-23
12214938
Am J Trop Med Hyg. 2001 May-Jun;64(5-6):229-32
11463108
Am J Trop Med Hyg. 2000 Apr;62(4):524-9
11220772
Trop Med Int Health. 1998 Jan;3(1):3-8
9484961
Trans R Soc Trop Med Hyg. 1990;84 Suppl 2:1-65
2219249
BMJ. 2001 Jul 7;323(7303):42-6
11440947
Acta Trop. 1999 Oct 15;73(3):231-6
10546840
N Engl J Med. 1996 Jul 11;335(2):69-75
8649492
East Afr Med J. 1999 Aug;76(8):421-4
10520345
Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004391
15495107
Br J Clin Pharmacol. 2002 May;53(5):492-500
11994055
BMJ. 2005 Feb 12;330(7487):334
15705690
Am J Respir Crit Care Med. 2006 Sep 1;174(5):605-14
16931644
BMJ. 2003 Sep 6;327(7414):557-60
12958120