BACKGROUND: Severe @entity311 kills over a million @entity1 every year. We sought evidence of superiority of @entity506 compared with the standard treatment @entity4807 . OBJECTIVES: To compare @entity506 with @entity4807 for treating severe @entity311 . SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (January 2007), CENTRAL (The Cochrane Library 2006, Issue 4), MEDLINE (1966 to January 2007), EMBASE (1974 to January 2007), LILACS (1982 to January 2007), ISI Web of Science (1945 to January 2007), the metaRegister of Controlled trials (mRCT), conference proceedings, and reference lists of articles. We contacted researchers and the World Health Organization. SELECTION CRITERIA: Randomized controlled trials comparing intravenous, intramuscular, or rectal @entity506 with intravenous or intramuscular @entity4807 for treating adults and @entity1 with severe @entity311 who are unable to take medication by mouth. DATA COLLECTION AND ANALYSIS: Two authors assessed the eligibility and methodological quality of trials, extracted and analysed data, and drafted the review. The third author contributed to the design and writing of the review. @entity204 was the primary outcome. Dichotomous outcomes were summarized using relative risks and continuous outcomes by mean differences. Where appropriate, we combined data in meta-analyses. Heterogeneity was investigated for the primary outcome using subgroup analyses. MAIN RESULTS: Six trials enrolling 1938 @entity1 (1664 adults and 274 @entity1 ) met our inclusion criteria. All six trials were conducted in Asia, and only one small trial enrolled only @entity1 . Five trials used intravenous @entity506 and one trial intramuscular @entity506 ; all six used intravenous @entity4807 . Treatment with @entity506 significantly reduced the risk of death (RR 0.62, 95% CI 0.51 to 0.75; 1938 @entity1 , 6 trials), reduced parasite clearance time (WMD 8.14 h, 95% CI 11.55 to 4.73; 292 @entity1 , 3 trials), and hypoglycaemia detected by routine monitoring (RR 0.46, 95% CI 0.25 to 0.87; 185 @entity1 , 2 trials). There was no evidence of a difference in neurological sequelae, @entity772 recovery time, time to hospital discharge, fever clearance time, or adverse effects other than hypoglycaemia. AUTHORS' CONCLUSIONS: Intravenous @entity506 is the drug of choice for adults with severe @entity311 , particularly if acquired in Asia. This review did not identify sufficient data to make firm conclusions about the treatment of @entity1 or the effectiveness of intramuscular @entity506 . There is an urgent need to compare the effects of @entity506 with @entity4807 in African @entity1 with severe @entity311 . The applicability of these results to Asian @entity1 and the ethics of further research are points of debate.

XXXX versus @entity4807 for treating severe @entity311 .

@entity1 :: ('9606', 'Species') :: ['participants', 'children', 'people'] @entity772 :: ('MESH:D003128', 'Disease') :: ['coma'] @entity4807 :: ('MESH:D011803', 'Chemical') :: ['quinine'] @entity506 :: ('MESH:C039726', 'Chemical') :: ['artesunate'] @entity311 :: ('MESH:D008288', 'Disease') :: ['malaria'] @entity204 :: ('MESH:D003643', 'Disease') :: ['Death']
@entity506 :: (MESH:C039726,Chemical) :: ['Artesunate']
