Sinclair David, Donegan Sarah, Lalloo David G
International Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK, L3 5QA.
Cochrane Database Syst Rev. 2011 Mar 16(3):CD005967. doi: 10.1002/14651858.CD005967.pub3.
Severe malaria results in over a million deaths every year, most of them in children aged under five years and living in sub-Saharan Africa. This review examines whether treatment with artesunate, instead of the standard treatment quinine, would result in fewer deaths and better treatment outcomes.
To compare artesunate with quinine for treating severe malaria.
We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, ISI Web of Science, the metaRegister of Controlled trials (mRCT), conference proceedings, and reference lists of articles to November 2010.
Randomized controlled trials comparing intravenous, intramuscular, or rectal artesunate with intravenous or intramuscular quinine for treating adults and children with severe malaria who are unable to take medication by mouth.
Two authors independently assessed the eligibility and risk of bias of trials, and extracted and analysed data. The primary outcome was all-cause death. Dichotomous outcomes were summarized using risk ratios (RR) and continuous outcomes by mean differences (MD). Where appropriate, we combined data in meta-analyses.
Eight trials enrolling 1664 adults and 5765 children are included in this review.Treatment with artesunate significantly reduced the risk of death both in adults (RR 0.61, 95% Confidence Interval (CI) 0.50 to 0.75; 1664 participants, five trials) and children (RR 0.76, 95% CI 0.65 to 0.90; 5765 participants, four trials)In children, treatment with artesunate increased the incidence of neurological sequelae at the time of hospital discharge. The majority of these sequelae were transient and no significant difference between treatments was seen at later follow up.
AUTHORS' CONCLUSIONS: The evidence clearly supports the superiority of parenteral artesunate over quinine for the treatment of severe malaria in both adults and children and in different regions of the world.
严重疟疾每年导致超过100万人死亡，其中大多数是撒哈拉以南非洲地区5岁以下的儿童。本综述探讨使用青蒿琥酯而非标准治疗药物奎宁进行治疗是否会降低死亡率并带来更好的治疗效果。
比较青蒿琥酯与奎宁治疗严重疟疾的效果。
我们检索了Cochrane传染病组专业注册库、Cochrane系统评价数据库（Cochrane图书馆）、MEDLINE、EMBASE、拉丁美洲和加勒比卫生科学数据库（LILACS）、科学引文索引（ISI Web of Science）、对照试验元注册库（mRCT）、会议论文集以及截至2010年11月的文章参考文献列表。
比较静脉注射、肌肉注射或直肠给药的青蒿琥酯与静脉注射或肌肉注射奎宁，用于治疗无法口服药物的严重疟疾成人和儿童的随机对照试验。
两位作者独立评估试验的纳入资格和偏倚风险，并提取和分析数据。主要结局是全因死亡。二分法结局采用风险比（RR）进行总结，连续性结局采用均值差（MD）进行总结。在适当情况下，我们在荟萃分析中合并数据。
本综述纳入了8项试验，涉及1664名成人和5765名儿童。青蒿琥酯治疗显著降低了成人（RR 0.61，95%置信区间（CI）0.50至0.75；1664名参与者，5项试验）和儿童（RR 0.76，95%CI 0.65至0.90；5765名参与者，4项试验）的死亡风险。在儿童中，青蒿琥酯治疗增加了出院时神经后遗症的发生率。这些后遗症大多是短暂的，在后期随访中未发现治疗组之间存在显著差异。
证据明确支持在全球不同地区，胃肠外青蒿琥酯治疗严重疟疾在成人和儿童中均优于奎宁。
