Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria

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Okoromah, C.A.
Afolabi, B.B.
Wall, E.C.
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Cochrane Database Syst Rev
Cerebral oedema occurs with cerebral malaria, and some clinicians think osmotic diuretics, such as mannitol or urea, may improve outcomes. Objectives To compare mannitol or urea to placebo or no diuretic for treating children or adults with cerebral malaria. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (Issue 4, 2010), CENTRAL (The Cochrane Library Issue 12, 2010), MEDLINE (1966 to November 2010), EMBASE (1974 to November 2010), LILACS (1982 to November 2010), and the reference lists of articles. We contacted relevant organizations and researchers. Selection criteria Randomized or quasi-randomized controlled trials comparing mannitol or urea to placebo or no treatment in children and adults with cerebral malaria. Primary outcomes were death, life-threatening sequelae and major neurological sequelae at six months. Data collection and analysis Two authors applied the inclusion criteria, assessed risk of bias, and extracted data independently. Main results One trial met the inclusion criteria, comparing mannitol 20% to saline placebo in 156 Ugandan children. Allocation was concealed. No difference in mortality, time to regain consciousness, or neurological sequelae were detected.
Okoromah CA, Afolabi BB, Wall EC. Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria. Cochrane Database Syst Rev. 2011 Apr 13;(4):CD004615. doi: 10.1002/14651858.CD004615.pub3. Review. PubMed PMID: 21491391; PubMed Central PMCID: PMC4018680.