Thirty-nine studies were included in the review (n = 1,224).
Artesunate (19 studies, n=643): Parasite clearance during the first 12 hours was generally slower in studies using doses below 5 mg/kg than in those using higher doses. Six patients (1.7%) died in studies of severe malaria and two (0.7%) in studies of moderately severe infection.
Artemisinin (10 studies, n=350): In six studies which reported time to 50% reduction in parasitaemia, the mean or median time ranged from 7 to 11.3 hours. Weighted mean mortality was 12.9%.
Dihydroartemisinin (two studies, n=180): One of the two studies clearly reported parasite clearance data, density rose to 30% above baseline at 12 hours and fell to 70% at 24 hours. No deaths were reported in either study.
Artemether (one study, n=51): The single small study found a parasite clearance time of 54.2 hours and a mortality rate of 11.7%.
Comparative studies (eight studies): Studies showed that rectal artesunate was associated with greater reductions in parasitaemia than parenteral quinine (one study) and greater reductions in parasite density compared to intramuscular artemether (one study) but there was no significant difference in other outcomes. Other studies showed significantly faster parasite clearance associated with artemisinin suppositories compared to intravenous or intramuscular quinine (three studies), and more rapid total parasite clearance time with dihydroartemisinin suppositories compared to intravenous quinine (one study). Studies showed no significant treatment differences for other outcomes. One study reported no significant differences between rectal artemether and intravenous quinine for any outcomes.