Parenteral artemisinin based therapy versus parenteral quinine in the treatment of severe Malaria : a comprehensive literature review

Abstract

BACKGROUND Prompt effective treatment is central in preventing death in severe malaria. Several studies have compared different artemisinin derivatives to quinine in the treatment of severe malaria. Recently, there have been reports of delayed hemolysis after parenteral artesunate use in the treatment of severe malaria. This review seeks to answer the research question: parenteral artemisinin derivatives versus parenteral quinine which is better, in efficacy and adverse events for the treatment of severe malaria? METHODS All relevant studies on the efficacy and/or adverse events of artemisinin derivatives in the treatment of severe malaria were included in this review. Data bases searched were: MEDLINE, the Cochrane Library, EMBASE and Google. RESULTS 31 studies were included (15,174 participants). Artemisinin derivatives had lower mortality compared to quinine. Artemisinin derivatives had similar duration of hospital stay compared to quinine. Artemisinin derivatives resolved coma faster, cleared parasites faster and cleared fever faster than quinine. More cases of hypoglycemia, hearing disturbances, visual disturbances, prolongation of QTc interval, hepatotoxicity and acute renal failure were reported in quinine than in the artemisinin derivatives. More cases of delayed haemolysis were reported in the artemisinin derivatives, specifically artesunate, compared to quinine. CONCLUSION Artemisinin derivatives have more efficacy and less adverse events compared to quinine. There is a need for pharmocavigilance after parenteral artesunate use for 4 weeks.