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Comparison 1 Artesunate vs quinine, Outcome 1 Death.
Figuras y tablas -
Analysis 1.1

Comparison 1 Artesunate vs quinine, Outcome 1 Death.

Comparison 1 Artesunate vs quinine, Outcome 2 Death: time since admission to hospital [subgroup analysis].
Figuras y tablas -
Analysis 1.2

Comparison 1 Artesunate vs quinine, Outcome 2 Death: time since admission to hospital [subgroup analysis].

Comparison 1 Artesunate vs quinine, Outcome 3 Death: allocation concealment [subgroup analysis].
Figuras y tablas -
Analysis 1.3

Comparison 1 Artesunate vs quinine, Outcome 3 Death: allocation concealment [subgroup analysis].

Comparison 1 Artesunate vs quinine, Outcome 4 Death: cerebral malaria [subgroup analysis].
Figuras y tablas -
Analysis 1.4

Comparison 1 Artesunate vs quinine, Outcome 4 Death: cerebral malaria [subgroup analysis].

Comparison 1 Artesunate vs quinine, Outcome 5 Death: loading dose vs no loading dose of quinine [subgroup analysis].
Figuras y tablas -
Analysis 1.5

Comparison 1 Artesunate vs quinine, Outcome 5 Death: loading dose vs no loading dose of quinine [subgroup analysis].

Comparison 1 Artesunate vs quinine, Outcome 6 Death: participant age [subgroup analysis].
Figuras y tablas -
Analysis 1.6

Comparison 1 Artesunate vs quinine, Outcome 6 Death: participant age [subgroup analysis].

Comparison 1 Artesunate vs quinine, Outcome 7 Death: intravenous vs intramuscular artesunate [subgroup analysis].
Figuras y tablas -
Analysis 1.7

Comparison 1 Artesunate vs quinine, Outcome 7 Death: intravenous vs intramuscular artesunate [subgroup analysis].

Comparison 1 Artesunate vs quinine, Outcome 8 Neurological sequelae at discharge.
Figuras y tablas -
Analysis 1.8

Comparison 1 Artesunate vs quinine, Outcome 8 Neurological sequelae at discharge.

Comparison 1 Artesunate vs quinine, Outcome 9 Coma recovery time.
Figuras y tablas -
Analysis 1.9

Comparison 1 Artesunate vs quinine, Outcome 9 Coma recovery time.

Comparison 1 Artesunate vs quinine, Outcome 10 Time to hospital discharge.
Figuras y tablas -
Analysis 1.10

Comparison 1 Artesunate vs quinine, Outcome 10 Time to hospital discharge.

Comparison 1 Artesunate vs quinine, Outcome 11 Fever clearance time.
Figuras y tablas -
Analysis 1.11

Comparison 1 Artesunate vs quinine, Outcome 11 Fever clearance time.

Comparison 1 Artesunate vs quinine, Outcome 12 Parasite clearance time of 50%.
Figuras y tablas -
Analysis 1.12

Comparison 1 Artesunate vs quinine, Outcome 12 Parasite clearance time of 50%.

Comparison 1 Artesunate vs quinine, Outcome 13 Hypoglycaemia.
Figuras y tablas -
Analysis 1.13

Comparison 1 Artesunate vs quinine, Outcome 13 Hypoglycaemia.

Table 1. Risk of bias assessment

Trial

Randomizationa

Concealmenta

Blinding

Inclusiona

Anh 1989

Adequate

Inadequate

Open label

Unclear

Hien 1992

Adequate

Adequate

Participant blinded

Unclear

Anh 1995

Adequate

Adequate

Open label

Unclear

Cao 1997

Adequate

Adequate

Open label

Adequate (100%)

Newton 2003

Adequate

Inadequate

Open label

Adequate (100%)

Dondorp 2005

Adequate

Adequate

Open label (trial centre, microscopists assessing blood slides, and data analysts blinded until trial end)

Adequate (100%)

aGeneration of allocation sequence, allocation concealment, and inclusion of all randomized participants.

Figuras y tablas -
Table 1. Risk of bias assessment
Comparison 1. Artesunate vs quinine

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death Show forest plot

6

1938

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.51, 0.75]

2 Death: time since admission to hospital [subgroup analysis] Show forest plot

3

3292

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.52, 0.81]

2.1 Death within 48 h

3

1646

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.57, 1.05]

2.2 Death after 48 h

3

1646

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.38, 0.74]

3 Death: allocation concealment [subgroup analysis] Show forest plot

6

1938

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.51, 0.75]

3.1 Adequate allocation concealment

4

1784

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.51, 0.77]

3.2 Inadequate allocation concealment

2

154

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.22, 0.97]

4 Death: cerebral malaria [subgroup analysis] Show forest plot

6

1938

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.51, 0.75]

4.1 All participants have cerebral malaria

3

292

Risk Ratio (M‐H, Fixed, 95% CI)

0.44 [0.25, 0.78]

4.2 Severe malaria

3

1646

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.52, 0.80]

5 Death: loading dose vs no loading dose of quinine [subgroup analysis] Show forest plot

6

1938

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.51, 0.75]

5.1 No loading dose

2

251

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.25, 0.87]

5.2 Loading dose

4

1687

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.52, 0.78]

6 Death: participant age [subgroup analysis] Show forest plot

6

1938

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.51, 0.75]

6.1 Adults (15/16 years +)

4

405

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.29, 0.75]

6.2 Children 2 to 15 years

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.22, 2.59]

6.3 All ages

1

1461

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.52, 0.81]

7 Death: intravenous vs intramuscular artesunate [subgroup analysis] Show forest plot

6

1938

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.51, 0.75]

7.1 Intravenous artesunate

5

1866

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.50, 0.75]

7.2 Intramuscular artesunate

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.22, 2.59]

8 Neurological sequelae at discharge Show forest plot

2

1253

Risk Ratio (M‐H, Fixed, 95% CI)

2.21 [0.64, 7.63]

9 Coma recovery time Show forest plot

2

231

Mean Difference (IV, Random, 95% CI)

2.11 [‐19.17, 23.40]

10 Time to hospital discharge Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

11 Fever clearance time Show forest plot

2

251

Mean Difference (IV, Random, 95% CI)

‐13.58 [‐55.09, 27.92]

12 Parasite clearance time of 50% Show forest plot

3

292

Mean Difference (IV, Random, 95% CI)

‐8.14 [‐11.55, ‐4.73]

13 Hypoglycaemia Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 Routine monitoring

2

185

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.25, 0.87]

13.2 Clinical monitoring

1

1461

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.13, 0.79]

Figuras y tablas -
Comparison 1. Artesunate vs quinine