Mannitol as adjunct therapy for childhood cerebral malaria in Uganda: a randomized clinical trial

Area of Science:

• Pediatric infectious diseases
• Neurocritical care
• Pharmacology

Background:

• Raised intracranial pressure (ICP) is a significant factor in childhood cerebral malaria mortality.
• Mannitol, an osmotic diuretic, is used for post-traumatic ICP but its efficacy in cerebral malaria is unclear.
• Investigating mannitol's impact on clinical outcomes in cerebral malaria is crucial.

Purpose of the Study:

• To determine the effect of intravenous mannitol as an adjunct therapy on the clinical outcome of children with cerebral malaria.
• To evaluate mannitol's impact on recovery time, duration of hospitalization, and mortality.

Main Methods:

• A randomized, double-blind, placebo-controlled trial involving 156 children (6-60 months) with cerebral malaria.
• Participants received either intravenous quinine with a single dose of mannitol (1 g/kg) or placebo.
• Outcomes measured included coma recovery, motor milestones, oral intake, hospitalization duration, mortality, and adverse effects.

Main Results:

• No significant differences were observed in time to regain consciousness, sit unsupported, or start oral intake between mannitol and placebo groups.
• Total coma duration and mortality rates were similar: 16.3% in the placebo group versus 13.2% in the mannitol group.
• No adverse effects were reported with mannitol administration.

Conclusions:

• Intravenous mannitol did not significantly impact the clinical outcome of childhood cerebral malaria.
• Current evidence does not support the use of intravenous mannitol as an adjunct therapy for cerebral malaria in children.
• Further research may be needed to explore alternative or refined treatment strategies.