Article type
Year
Abstract
Background:
In 2011 the World Health Organization (WHO) recommended that artesunate replace quinine to treat severe malaria. However, many African countries had already started to use artemether, about which the WHO made no statement. The Better Medicines for Children Project in Ghana, 2011, which aimed to introduce the use of evidence-based methods into the Ghana medicines selection process highlighted this problem, so we carried out a Cochrane Review of artemether in severe malaria, updating an earlier analysis.
Methods:
We conducted a Cochrane systematic review and we combined data in meta-analyses where appropriate and the quality of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.
Results:
We included 18 trials, enrolling 2662 participants with severe malaria. For children in Africa, intramuscular artemether is probably equivalent to quinine for preventing death. For older children and adults in Asia, artemether probably reduces deaths compared to quinine (moderate quality evidence). In Asia, mortality is probably higher with intramuscular artemether compared to artesunate (moderate quality evidence).
Conclusions:
Artemether appears to be equivalent to quinine for treating children with severe malaria, and may have advantages with easier administration. Indirect high quality evidence that artesunate is superior to quinine implies that artesunate should remain the treatment of choice for children with severe malaria. This systematic review was submitted to the WHO guidelines committee to be part of formulation and revision of policy to be contained in the World Health Organization Global Guidelines for treatment and Chemoprevention of malaria 3rd Edition
In 2011 the World Health Organization (WHO) recommended that artesunate replace quinine to treat severe malaria. However, many African countries had already started to use artemether, about which the WHO made no statement. The Better Medicines for Children Project in Ghana, 2011, which aimed to introduce the use of evidence-based methods into the Ghana medicines selection process highlighted this problem, so we carried out a Cochrane Review of artemether in severe malaria, updating an earlier analysis.
Methods:
We conducted a Cochrane systematic review and we combined data in meta-analyses where appropriate and the quality of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.
Results:
We included 18 trials, enrolling 2662 participants with severe malaria. For children in Africa, intramuscular artemether is probably equivalent to quinine for preventing death. For older children and adults in Asia, artemether probably reduces deaths compared to quinine (moderate quality evidence). In Asia, mortality is probably higher with intramuscular artemether compared to artesunate (moderate quality evidence).
Conclusions:
Artemether appears to be equivalent to quinine for treating children with severe malaria, and may have advantages with easier administration. Indirect high quality evidence that artesunate is superior to quinine implies that artesunate should remain the treatment of choice for children with severe malaria. This systematic review was submitted to the WHO guidelines committee to be part of formulation and revision of policy to be contained in the World Health Organization Global Guidelines for treatment and Chemoprevention of malaria 3rd Edition