A Cochrane review [Abstract] 1 included 10 studies with a total of 1 805 subjects. One trial compared artesunate plus mefloquine with quinine and reported fewer treatment failures at day 63 with the combination (RR 0.09, 95% CI 0.02 to 0.38; n=106). One trial reported fewer treatment failures at day 63 with artesunate plus atovaquone-proguanil compared with quinine (RR 0.14, 95% CI 0.03 to 0.57; n=80). One trial reported fewer treatment failures at day 28 when amodiaquine was compared with chloroquine (RR 0.20, 95% CI 0.08 to 0.46; n=420) and when amodiaquine plus sulfadoxine-pyrimethamine was compared with chloroquine (RR 0.02, 95% CI 0.00 to 0.26; n=418). Compared with sulfadoxine-pyrimethamine given alone, one trial reported fewer treatment failures at delivery (or day 40) with artesunate plus sulfadoxine-pyrimethamine (RR 0.15, 95% CI 0.04 to 0.59; n=79) and azithromycin plus sulfadoxine-pyrimethamine (RR 0.27, 95% CI 0.10 to 0.76; n=82).
None of the trials included women in their first trimester. Most trials supervised treatment or followed up the participants intensively. Hence, trials may not reflect what effects the treatments would have had when used in standard conditions.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding), by inconsistency (heterogeneity in interventions and outcomes), and by indirectness (differences in studied patients).
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