title: Should we abandon quinine plus antibiotic for treating uncomplicated falciparum malaria? A systematic review and meta-analysis of randomized controlled trials.
abstract: In this study, we compared the efficacies and adverse effects of quinine plus antibiotics and other anti-malaria drugs on treating uncomplicated falciparum malaria. By systematically searching the major databases PubMed, Embase, and the Cochrane Library, 14 randomized controlled trials (RCTs) including 1996 cases were identified. Then, we performed a systematic review and cumulative meta-analysis on these data. The primary outcome of these treatments was parasite failure at day 28. There was no significant difference between quinine plus antibiotic therapy (QACT) and artemisinin-based therapies (odds ratio (OR) 0.69, 95 % confidence interval (CI) 0.28 to 1.71) or non-artemisinin-based therapies except quinine monotherapy and chloroquine monotherapy (OR 0.56, 95 % CI 0.18 to 1.74). The secondary outcome was the adverse effects within 28 days, including nausea, dizziness, vomiting, diarrhea, abdominal pain, headache, and tinnitus. QACT significantly increased the risk of tinnitus compared with artemisinin-based therapies (OR 111.65, 95 % CI 12.63 to 986.87) and non-artemisinin-based therapies (OR 48.16, 95 % CI 16.23 to 142.92). Vomiting was more frequently reported in QACT compared with non-artemisinin-based therapies (OR 2.02, 95 % CI 1.14 to 3.56). This meta-analysis suggests that almost all regimens have equivalent treatment effect at the 28th day. However, the patients with QACT had a higher chance to suffer from vomiting and tinnitus. Therefore, QACT does not have significant advantage on treating uncomplicated falciparum malaria.
authors.affiliation: Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China. songtianzhang@163.com.|Education Ministry Key Laboratory for Tropical Disease Control Research, Sun Yat-sen University, Guangzhou, Guangdong, China. songtianzhang@163.com.
authors.forename: Tianzhang
authors.initials: T
authors.lastname: Song
authors.affiliation: Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong, China. 121863540@qq.com.
authors.forename: Jintao
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Dermatology and Venereology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. 921295597@qq.com.
authors.forename: Lilin
authors.initials: L
authors.lastname: Huang
authors.affiliation: School of Biomedical Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong. Wenjiagan@Hotmail.com.
authors.forename: Wenjia
authors.initials: W
authors.lastname: Gan
authors.affiliation: Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China. 13207468482@163.com.|Education Ministry Key Laboratory for Tropical Disease Control Research, Sun Yat-sen University, Guangzhou, Guangdong, China. 13207468482@163.com.
authors.forename: Hongling
authors.initials: H
authors.lastname: Yin
authors.affiliation: Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China. 1062285683@qq.com.|Education Ministry Key Laboratory for Tropical Disease Control Research, Sun Yat-sen University, Guangzhou, Guangdong, China. 1062285683@qq.com.
authors.forename: Juan
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Department of Dermatology and Venereology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. 378849150@qq.com.
authors.forename: Tailong
authors.initials: T
authors.lastname: He
authors.affiliation: Department of Dermatology and Venereology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. hhuaiqiu@medmail.com.cn.
authors.forename: Huaiqiu
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China. huxuchu@mail.sysu.edu.cn.|Education Ministry Key Laboratory for Tropical Disease Control Research, Sun Yat-sen University, Guangzhou, Guangdong, China. huxuchu@mail.sysu.edu.cn.
authors.forename: Xuchu
authors.initials: X
authors.lastname: Hu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D011803:Quinine / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials; D011803:Quinine
keywords: PubMed; Quinine; Uncomplicated falciparum malaria