Cerebral malaria can lead to coma and death, even when the patient is given anti-malarial drugs. Death is caused by the malaria parasites in the brain that cause brain swelling, leading to pressure in the brain. Mannitol is a drug that sometimes reduces brain swelling in other situations, such as traumatic head injury.
We searched for studies testing mannitol given in addition to anti-malarial drugs in children with cerebral malaria. One study, carried out in Uganda, was found. A total of 156 children were randomly divided to receive either mannitol or placebo (saline solution) in addition to quinine, which is an anti-malarial drug. No difference in either the numbers of deaths, or the time to recover from coma was found in this study. More studies are needed, but from this review mannitol cannot be currently recommended for use in cerebral malaria.