Comparison of Artemether Versus Quinine for the Treatment of Cerebral Malaria in Children: A Meta-Analysis of Randomized Controlled Trials.

Abstract

Malaria is a potentially life-threatening parasitic disease caused by a protozoal infection via Plasmodium species, transmitted by a carrier female Anopheles mosquito. Cerebral malaria is typically caused by Plasmodium falciparum and is known as a fatal neurological complication of malaria. This systematic review and meta-analysis was performed due to limited research on the comparison of artemether and quinine for the treatment of cerebral malaria in children. Several electronic databases (PubMed, Cochrane Library, and Scopus) were searched from inception to February 2023. Additionally, risk of bias and quality assessment were performed using the Cochrane Risk of Bias Tool for Randomized Controlled Trials. A total of 7 studies were pooled, including 618 patients receiving artemether and 607 patients receiving quinine, leading to a pooling of 1,225 patients in this meta-analysis. It was observed that parasite clearance time (mean difference (MD): -7.63; 95% confidence interval (CI): -11.06, -4.21, P < 0.0001) was significantly improved in the artemether cohort. However, fever clearance time, coma clearance time, and mortality rate failed to reach statistically significant differences. In summary, artemether demonstrated a mildly superior efficacy in comparison to quinine. Thus, regions with artemisinin-sensitive strains of malaria are encouraged to continue the use of artemisinin; however, regions with artemisinin resistance may consider the use of quinine as an alternative in the treatment of cerebral malaria in children. Future comprehensive randomized controlled studies are needed to arrive at a robust conclusion.