title: Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria.
abstract: BACKGROUND
  Cerebral oedema occurs with cerebral malaria, and some clinicians think osmotic diuretics, such as mannitol or urea, may improve outcomes.
  
  
  OBJECTIVE
  To compare mannitol or urea to placebo or no diuretic for treating children or adults with cerebral malaria.
  
  
  METHODS
  We searched the Cochrane Infectious Diseases Group Specialized Register (Issue 4, 2010), CENTRAL (The Cochrane Library Issue 12, 2010), MEDLINE (1966 to November 2010), EMBASE (1974 to November 2010), LILACS (1982 to November 2010), and the reference lists of articles. We contacted relevant organizations and researchers.
  
  
  METHODS
  Randomized or quasi-randomized controlled trials comparing mannitol or urea to placebo or no treatment in children and adults with cerebral malaria. Primary outcomes were death, life-threatenining sequelae and major neurological sequelae at six months.
  
  
  METHODS
  Two authors applied the inclusion criteria, assessed risk of bias, and extracted data independently.
  
  
  RESULTS
  One trial met the inclusion criteria, comparing mannitol 20% to saline placebo in 156 Ugandan children. Allocation was concealed. No difference in mortality, time to regain consciousness, or neurological sequelae were detected.
  
  
  CONCLUSIONS
  There are insufficient data to know what the effects of osmotic diuretics are in children with cerebral malaria. Larger, multicentre trials are needed.
authors.affiliation: Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Idi-Araba, Surulere, Lagos, Lagos, Nigeria, PMB 12003.
authors.forename: Christy An
authors.initials: CA
authors.lastname: Okoromah
authors.forename: Bosede B
authors.initials: BB
authors.lastname: Afolabi
authors.forename: Emma Cb
authors.initials: EC
authors.lastname: Wall
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D002648:Child; D004234:Diuretics, Osmotic / Q000627:therapeutic use*; D006801:Humans; D016779:Malaria, Cerebral / Q000188:drug therapy*; D008353:Mannitol / Q000627:therapeutic use*; D011803:Quinine / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014454:Uganda; D014508:Urea / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D004234:Diuretics, Osmotic; D008353:Mannitol; D014508:Urea; D011803:Quinine