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Malaria: severe, life-threatening

Susanne Helena Sheehy1, Brian John Angus

  • 1University of Oxford, Oxford, UK.

BMJ Clinical Evidence
|March 8, 2011
PubMed

Insights

This systematic review evaluates antimalarial treatments for severe falciparum malaria in non-pregnant individuals. It examines the effectiveness and safety of various interventions, including artemisinin derivatives and quinine, to guide clinical practice.

Area of Science:

  • Infectious Diseases
  • Tropical Medicine
  • Pharmacology

Background:

  • Severe malaria, particularly *Plasmodium falciparum*, poses a significant threat to young children, non-immune travelers, and residents of endemic areas.
  • Cerebral malaria can lead to encephalopathy and coma, with a fatality rate of approximately 20% and potential for long-term neurological deficits in survivors.
  • Severe malarial anemia is another critical complication, associated with a mortality rate exceeding 13%.

Purpose of the Study:

  • To systematically review the efficacy and safety of antimalarial treatments and adjunctive therapies for complicated *falciparum* malaria in non-pregnant individuals.
  • To answer key clinical questions regarding the effects of various interventions based on available scientific evidence.

Main Methods:

  • Conducted a systematic literature review up to December 2009, searching major databases like Medline, Embase, and The Cochrane Library.
  • Included data from 33 systematic reviews, randomized controlled trials (RCTs), and observational studies meeting inclusion criteria.
  • Incorporated safety alerts from regulatory agencies such as the US FDA and UK MHRA.

Main Results:

  • Identified and analyzed data from 33 relevant studies.
  • Evaluated a range of antimalarial treatments and supportive care interventions.

Conclusions:

  • The review synthesizes information on the effectiveness and safety of key interventions for severe malaria.
  • Interventions examined include dexamethasone, blood transfusions (exchange and initial), quinine, and various artemisinin derivatives (intramuscular and intravenous artemether, artesunate, dihydroartemisinin).
  • Provides evidence-based insights into managing complicated *falciparum* malaria.
Abstract

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