Intravenous Artesunate for the Treatment of Severe and Complicated Malaria in the United States: Clinical Use Under An Investigational New Drug Protocol

This retrospective case series (n=102) found IV artesunate appeared to be a safe and effective alternative to quinidine for severe and complicated malaria. Symptoms generally improved/resolved within 3 days; all deaths and most adverse events were attributed to disease severity.

UK malaria treatment guidelines from the British Infection Association (last published 2007) note that IV quinine dihydrochloride is currently the first-line antimalarial drug for the treatment of severe malaria in the UK, parenteral therapy should be continued until the patient can take oral therapy (total 5-7 days of quinine in total).  Quinine treatment should always be accompanied by a second drug (doxycycline or clindamycin), given orally for total of 7 days from when the patient can swallow.

 

An IV artesunate regimen is an alternative, but this is not licensed in the EU. It can be made available from specialist tropical disease centres on expert consultation, for the treatment of specific cases where the benefits outweigh the potential disadvantages of using an unlicensed drug. This includes patients with parasite counts over 20%, very severe disease, deterioration on optimal doses of quinine, cardiovascular disease that increases the risks from quinine or patients with falciparum malaria from SE Asia where relative quinine resistance is most likely.