A Cochrane review [Abstract] 1 included 10 studies with a total of 1417 children; only 3 of the studies (n=245) included participants with severe malaria. Seven trials compared intrarectal with intravenous quinine, and seven trials compared it with intramuscular treatment. No statistically significant difference was found between the different routes of administration for death, parasite clearance by 48 hours and 7 days, parasite clearance time, fever clearance time, coma recovery time, duration of hospitalization, and time to drinking. One large trial (898 children) reported that intrarectal was less painful than intramuscular administration.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment ), and by imprecise results (limited study size for each comparison).
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