ReviewBMC infectious diseases2008
Rectal artemisinins for malaria: a review of efficacy and safety from individual patient data in clinical studies.
Review in BMC infectious diseases, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 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
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 71 citations in OpenAlex.
- Pre-referral rectal artesunate for severe malaria.The Cochrane database of systematic reviews · 2014Pooled it
- Malaria: severe, life-threatening.BMJ clinical evidence · 2011Pooled it
- Pharmacokinetic Study of Rectal Artesunate in Children with Severe Malaria in Africa.Antimicrobial agents and chemotherapy · 2021Trial
- Efficacy of a novel sublingual spray formulation of artemether in African children with Plasmodium falciparum malaria.Antimicrobial agents and chemotherapy · 2015Trial
- Assessing caregivers' perceptions of treatment-seeking for suspected severe malaria in the Democratic Republic of the Congo.Malaria journal · 2023Article
- Rectal artesunate for severe malaria, implementation research, Zambia.Bulletin of the World Health Organization · 2023Article
- The CARAMAL study could not assess the effectiveness of rectal artesunate in treating suspected severe malaria.BMC medicine · 2023Article
- Effectiveness of rectal artesunate as pre-referral treatment for severe malaria in children under 5 years of age: a multi-country observational study.BMC medicine · 2022Observational
- Key factors predicting suspected severe malaria case management and health outcomes: an operational study in the Democratic Republic of the Congo.Malaria journal · 2022Observational
- Prereferral rectal artesunate and referral completion among children with suspected severe malaria in the Democratic Republic of the Congo, Nigeria and Uganda.BMJ global health · 2022Observational
- Pharmacokinetics and Pharmacodynamics of Clofazimine for Treatment of Cryptosporidiosis.Antimicrobial agents and chemotherapy · 2022Article
- Use of rectal artesunate for severe malaria at the community level, Zambia.Bulletin of the World Health Organization · 2019Observational
- Caregivers' compliance with referral advice: evidence from two studies introducing mRDTs into community case management of malaria in Uganda.BMC health services research · 2018Article
- Cost effectiveness of pre-referral antimalarial treatment in severe malaria among children in sub-Saharan Africa.Cost effectiveness and resource allocation : C/E · 2017Article
- Introducing the concept of a new pre-referral treatment for severely ill febrile children at community level: a sociological approach in Guinea-Bissau.Malaria journal · 2014Article
- The global pipeline of new medicines for the control and elimination of malaria.Malaria journal · 2012Review
- P. falciparum in vitro killing rates allow to discriminate between different antimalarial mode-of-action.PloS one · 2012Article
- The parasite clearance curve.Malaria journal · 2011Article
- Artesunate: The Best Drug in the Treatment of Severe and Complicated Malaria.Pharmaceuticals (Basel, Switzerland) · 2010Review
- Understanding caretakers' dilemma in deciding whether or not to adhere with referral advice after pre-referral treatment with rectal artesunate.Malaria journal · 2010Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 4 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRectal administration of artemisinin derivatives has potential for early treatment for severe malaria in remote settings where injectable antimalarial therapy may not be feasible. Preparations available include artesunate, artemisinin, artemether and dihydroartemisinin. However each may have different pharmacokinetic properties and more information is needed to determine optimal dose and comparative efficacy with each another and with conventional parenteral treatments for severe malaria.
methodsIndividual patient data from 1167 patients in 15 clinical trials of rectal artemisinin derivative therapy (artesunate, artemisinin and artemether) were pooled in order to compare the rapidity of clearance of Plasmodium falciparum parasitaemia and the incidence of reported adverse events with each treatment. Data from patients who received comparator treatment (parenteral artemisinin derivative or quinine) were also included. Primary endpoints included percentage reductions in parasitaemia at 12 and 24 hours. A parasite reduction of >90% at 24 hours was defined as parasitological success.
resultsArtemisinin and artesunate treatment cleared parasites more rapidly than parenteral quinine during the first 24 hours of treatment. A single higher dose of rectal artesunate treatment was five times more likely to achieve >90% parasite reductions at 24 hours than were multiple lower doses of rectal artesunate, or a single lower dose administration of rectal artemether.
conclusionArtemisinin and artesunate suppositories rapidly eliminate parasites and appear to be safe. There are less data on artemether and dihydroartemisinin suppositories. The more rapid parasite clearance of single high-dose regimens suggests that achieving immediate high drug concentrations may be the optimal strategy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.