Murphy 1996 KEN

Methods	Trial design: Open RCT Trial dates: Not stated
Participants	Number: 160 children aged five months to 12 years enrolled Inclusion criteria: Children were admitted to the trial if they had P. falciparum asexual parasitaemia, were comatose and parental consent was obtained. Exclusion criteria: Children were excluded if there was evidence of a pre‐existing neurological deficit, head injury, or history of recent treatment with antimalarial drugs other than chloroquine.
Interventions	1. Intramuscular artemether (Paluther, Rhône‐Poulenc) Loading dose of 3.2 mg/kg Followed by 1.6 mg/kg once daily. At least three doses of artemether were given Followed by sulphadoxine‐pyrimethamine if parasitaemia had cleared and the child could drink. Otherwise artemether was continued for a total of five days (four maintenance doses) 2. Intravenous quinine (Laboratoires Renaudin, Paris) Loading dose of 20 mg/kg infused over four hours Folowed by 10 mg/kg every eight hours with dose given over two hours. At least three doses of parenteral quinine were given, and continued until the child was able to drink and parasitaemia had cleared Then a single dose of sulphadoxine‐pyrimethamine (sulphadoxine 25 mg/kg, pyrimethamine 1.25 mg/kg) given orally or intramuscularly
Outcomes	Outcomes included in the review: Time to death Coma resolution Neurological sequelae Fever clearance Parasite clearance Adverse effects Outcomes not included in the review: Mortality with respiratory distress
Notes	Location: Kenya Medical Research Institute (KEMRI) Coastal Research Unit, Kilifi district hospital, Kenya. Transmission: Unknown Funding: KEMRI UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) The Wellcome Trust
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Centrally‐coded unique trial numbers.
Allocation concealment (selection bias)	Low risk	Sealed envelopes prepared by the clinical monitor.
Blinding (performance bias and detection bias) Objective outcome: Death	Low risk	An open‐label trial is unlikely to bias an objective outcome like death.
Blinding (performance bias and detection bias) Subjective outcomes: Others	High risk	An open‐label trial. Blinding unlikely as artemether and quinine were given by 2 different routes.
Incomplete outcome data (attrition bias) All outcomes	Low risk	40 patients (14 from artemether arm and 26 from quinine arm) excluded. Mostly for not meeting inclusion criteria.
Selective reporting (reporting bias)	Low risk	No evidence of selective reporting.
Other bias	Low risk	No other bias identified.