A Cochrane review [Abstract] 1 included 2 studies with a total of 143 subjects (both adults and children). Both studies compared intravenous dexamethasone plus antimalarial treatment (intravenous infusions of quinine) with antimalarial treatment alone. There were 30 deaths in the 2 studies, distributed evenly between the corticosteroid and control groups (RR 0.89, 95% CI 0.48 to 1.68). Clinical complications were reported as the number of events in each trial arm and did not exclude complications occurring in fatalities. This made it difficult to interpret the reports of significantly more episodes of gastrointestinal bleeding (RR 8.17, 95% CI 1.05 to 63.6; 2 studies, n=143) and seizures (RR 3.32, 95% CI 1.05 to 10.47; 2 studies, n=143) in the corticosteroid group. Neither trial examined disability.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding) and by imprecise results (few patients and wide confidence intervals).
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