Trial reportAntimicrobial agents and chemotherapy2006
Artesunate suppositories versus intramuscular artemether for treatment of severe malaria in children in Papua New Guinea.
Trial report in Antimicrobial agents and chemotherapy, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 5 syntheses or guidelines pooled it, 49 citations in OpenAlex.
- Artemether for severe malaria.The Cochrane database of systematic reviews · 2019Pooled it
- Artemether for severe malaria.The Cochrane database of systematic reviews · 2014Pooled it
- Pre-referral rectal artesunate for severe malaria.The Cochrane database of systematic reviews · 2014Pooled it
- Clinical features and outcome in children with severe Plasmodium falciparum malaria: a meta-analysis.PloS one · 2014Pooled it
- Malaria: severe, life-threatening.BMJ clinical evidence · 2011Pooled it
- Intramuscular Artesunate for Severe Malaria in African Children: A Multicenter Randomized Controlled Trial.PLoS medicine · 2016Trial
- Efficacy of a novel sublingual spray formulation of artemether in African children with Plasmodium falciparum malaria.Antimicrobial agents and chemotherapy · 2015Trial
- Pharmacokinetics of a novel sublingual spray formulation of the antimalarial drug artemether in African children with malaria.Antimicrobial agents and chemotherapy · 2015Trial
- Artesunate Inhibits Metastatic Potential in Cisplatin-Resistant Bladder Cancer Cells by Altering Integrins.Cells · 2025Article
- Pioneer Use of Antimalarial Transdermal Combination Therapy in Rodent Malaria Model.Pathogens (Basel, Switzerland) · 2023Article
- Community access to rectal artesunate for malaria (CARAMAL): A large-scale observational implementation study in the Democratic Republic of the Congo, Nigeria and Uganda.PLOS global public health · 2022Article
- Enhancing the antimalarial activity of artesunate.Parasitology research · 2020Review
- Preparations of Rectal Suppositories Containing Artesunate.Pharmaceutics · 2020Article
- Cost effectiveness of pre-referral antimalarial treatment in severe malaria among children in sub-Saharan Africa.Cost effectiveness and resource allocation : C/E · 2017Article
- Frequencies of Cytochrome P450 2B6 and 2C8 Allelic Variants in the Mozambican Population.The Malaysian journal of medical sciences : MJMS · 2013Article
- Population pharmacokinetics of intramuscular artesunate in African children with severe malaria: implications for a practical dosing regimen.Clinical pharmacology and therapeutics · 2013Article
- Antimalarial drug resistance: a review of the biology and strategies to delay emergence and spread.International journal of antimicrobial agents · 2013Review
- Meningeal inflammation increases artemether concentrations in cerebrospinal fluid in Papua New Guinean children treated with intramuscular artemether.Antimicrobial agents and chemotherapy · 2011Article
- Article
- Rectal artemisinins for malaria: a review of efficacy and safety from individual patient data in clinical studies.BMC infectious diseases · 2008Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Drug treatment of severe malaria must be rapidly effective. Suppositories may be valuable for childhood malaria when circumstances prevent oral or parenteral therapy. We compared artesunate suppositories (n = 41; 8 to 16 mg/kg of body weight at 0 and 12 h and then daily) with intramuscular (i.m.) artemether (n = 38; 3.2 mg/kg at 0 h and then 1.6 mg/kg daily) in an open-label, randomized trial with children with severe Plasmodium falciparum malaria in Papua New Guinea (PNG). Parasite density and temperature were measured every 6 h for > or = 72 h. Primary endpoints included times to 50% and 90% parasite clearance (PCT50 and PCT90) and the time to per os status. In a subset of 29 patients, plasma levels of artemether, artesunate, and their common active metabolite dihydroartemisinin were measured during the first 12 h. One suppository-treated patient with multiple complications died within 2 h of admission, but the remaining 78 recovered uneventfully. Compared to the artemether-treated children, those receiving artesunate suppositories had a significantly earlier mean PCT50 (9.1 versus 13.8 h; P = 0.008) and PCT90 (15.6 versus 20.4 h; P = 0.011). Mean time to per os status was similar for each group. Plasma concentrations of primary drug plus active metabolite were significantly higher in the artesunate suppository group at 2 h postdose. The earlier initial fall in parasitemia with artesunate is clinically advantageous and mirrors higher initial plasma concentrations of active drug/metabolite. In severely ill children with malaria in PNG, artesunate suppositories were at least as effective as i.m. artemether and may, therefore, be useful in settings where parenteral therapy cannot be given.
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