Artemether for severe malaria: A meta-analysis of randomized clinical trials

The treatment of choice for severe malaria is quinine. However, a gradual p rogression of resistance to quinine has become a concern in parts of the wo rld. Artemisinin-related compounds are a relatively new class of drugs. Thi s meta-analysis assesses the evidence regarding the clinical effectiveness of artemether for severe malaria. Computerized literature searches identifi ed all randomized clinical trials of artemether in comparison with quinine. Standardized data extraction was independently performed by both authors. Results of nine trials, entered in the meta-analysis, demonstrate the absen ce of a significant difference between artemether and quinine in terms of m ortality rate (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.50-1. 14). Statistical pooling of data from trials in Southeast Asia showed a tre nd toward enhanced reduction of mortality (OR, 0.38; 95% CI, 0.14-1.02). Th ese data demonstrate the equality of artemether and quinine for severe mala ria and indicate a trend toward greater effectiveness of artemether in regi ons where there is recognized quinine resistance.