Artesunate should replace quinine as the drug of choice for treating malaria, according to an updated review of clinical trial results.
Derived from herbs used in Chinese medicine, artesunate was found to be more effective at preventing death in people with severe malaria.
The Analysis
The review, published in the Cochrane Library, includes the findings of a large study of African children published last year in the Lancet and eight other clinical trials, all together involving 1,664 adults and 5,765 children from a number of areas in Africa and Asia.
The updated review shows that using artesunate to treat people with severe malaria reduces the risk for death by 39% in adults and 24% in children, compared with quinine. In adults, deaths fell from 241 per 1,000 with quinine to 147 with artesunate. In children, deaths were reduced from 108 per 1,000 with quinine to 83 with artesunate.
Side Effects
Neurological problems were more common among children given artesunate than among those who were given quinine, but most of the problems were resolved within a month of treatment and were outweighed by the increase in survival rates, the researchers said.
"The balance of benefits and harms is in favor of treatment with artesunate," David Sinclair, of the Liverpool School of Tropical Medicine in England, who led the review team, said in a Cochrane news release.
Dr. Peter Olumese, of the World Health Organization's Global Malaria Program, said in the news release that sufficient evidence now exists "to be confident of these results" and that "intravenous artesunate is now being recommended as the treatment of choice for adults and children with severe malaria anywhere in the world."
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