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ANNEX 8. Treatment of severe Plasmodium falciparum malaria

RCT was conducted in Indonesia, the other in Thailand. The review found no significant
difference in mortality (14/71 (20%) with dexamethasone, 16/72 (25%) with placebo, RR
0.89, 95% CI 0.47–1.68). One RCT found a longer mean time between start of treatment
and coma resolution with dexamethasone (76.0 h compared with 57.0 h, P < 0.02) (14),
but the other found no significant difference (83.4 h compared with 80.0 h, WMD +3.4 h,
95% CI −31.3 h to +38.1 h) (15).

Harms
The review found that dexamethasone significantly increased gastrointestinal bleeding
and seizures compared with placebo (gastrointestinal bleeding 7/71 (10%) with
dexamethasone, 0/72 (0%) with placebo, RR 8.17, 95% CI 1.05–63.6; seizures 1/71 (15.5%)
compared with 3/72 (4%), RR 3.32, 95% CI 1.05–10.47) (13).

comment
No effect of the steroid on mortality was shown, but the trials were small. Its effect on
disability was not reported.

a8.7 Question:
Should phenobarbital be given to patients?

Cochrane Review, search date: 2004 (16). Three RCTs with a total of 573 participants met
the inclusion criteria. All three compared phenobarbital with placebo or no treatment.
In the two trials with adequate allocation concealment, death was more common in the
anticonvulsant group (RR 2.0, 95% CI 1.20–3.33, fixed effect model). In all three trials,
phenobarbital was associated with fewer convulsions than placebo or no treatment (RR
0.30, 95% CI 0.19–0.45, fixed effect model). A8

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