Dr. David Sinclair, with the Liverpool School of Tropical Medicine, UK, and colleagues note that artesunate is one of several derivatives of artemisinin, which have become the recommended oral treatment for uncomplicated malaria in combination with other drugs — as Artemisinin-based Combination Therapy (ACT).
Artesunate can be given by intramuscular or intravenous injection, they add, and is the most studied artemisinin-derivative for the treatment of severe malaria. To update its efficacy versus quinine, the researchers identified eight randomized clinical trials involving 1664 adults and 5765 children with severe malaria who are unable to take medication by mouth.
The trials compared intravenous, intramuscular or rectal artesunate with intravenous or intramuscular quinine, and the primary outcome was mortality.
“Treatment with artesunate significantly reduced the risk of death both in adults (RR 0.61) and children (RR 0.76),” the authors found. “This reduction was consistent across all trials regardless of participant age or geographic region.”
Neurological complications at the time of discharge were more common with artesunate than with quinine (RR 1.41), but were largely transient. Specifically, 75.9% of children with neurologic sequelae were available for assessment on day 28, and of these 52.7% had fully recovered. At that point the difference between groups was not statistically significant (RR 1.23), Dr. Sinclair and colleagues report.
Based on these findings, they conclude, “Artesunate should be the drug of choice for adults and children with severe malaria worldwide.”
Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD005967