From the Guidelines
The recommended monitoring protocol for patients receiving artesunate for severe malaria involves checking parasitaemia every 12 hours until a decline to <1% is detected and then every 24 hours until negative, as well as daily monitoring of full blood count, hepatic, kidney, and metabolic exams, including glycaemia and blood gas analysis, with particular attention to potential complications such as hypoglycemia, acidosis, acute kidney injury, and delayed hemolytic anemia 1.
Key Monitoring Parameters
- Parasitaemia levels every 12 hours until <1% and then every 24 hours until negative
- Daily full blood count
- Daily hepatic function tests
- Daily kidney function tests
- Daily metabolic exams, including glycaemia and blood gas analysis
- Monitoring for delayed haemolysis on days 7,14,21, and 28 in patients treated with IV artesunate 1
Treatment Overview
The treatment of severe malaria with artesunate should be initiated immediately upon diagnosis, given the high mortality risk associated with delays in treatment, particularly in non-immune individuals. Artesunate is preferred over quinine due to its superior efficacy and safety profile, rapidly reducing parasite burden by targeting all stages of the parasite's development.
Supportive Care
Supportive care is essential and includes fluid management, blood transfusions if needed, anticonvulsants for seizures, and management of respiratory distress. The choice of oral artemisinin-based combination therapy (ACT) to follow intravenous artesunate should be based on the patient's ability to tolerate oral medication and the specific ACT's efficacy and safety profile.
Complications and Side Effects
Clinicians should be vigilant for complications such as hypoglycemia, acidosis, acute kidney injury, and delayed hemolytic anemia, which can occur during or after treatment with artesunate. The monitoring protocol should be adjusted based on the patient's clinical condition and the presence of any complications.
Evidence Basis
The recommended monitoring and treatment protocol is based on the most recent and highest quality evidence available, including guidelines from reputable sources such as the World Health Organization and peer-reviewed journals like Clinical Microbiology and Infection 1.
From the Research
Recommended Treatment Protocol
- The recommended treatment for severe malaria is intravenous artesunate (IVAS) 2, 3.
- IVAS has been shown to be safe and effective in reducing parasite clearance time, duration of intensive care, and hospital treatment in patients with severe malaria 2, 3.
Monitoring Protocol
- Patients receiving IVAS should be monitored for adverse events, such as post-artesunate delayed hemolysis, which can occur in some cases 2.
- Liver enzyme abnormalities have been reported in patients treated with artemisinin-based therapy, including artemether-lumefantrine, but these abnormalities are usually asymptomatic and self-limited 4.
- Monitoring of liver function may be necessary in patients receiving artemisinin-based therapy, especially in those with pre-existing liver disease 4.
Resistance Status
- Artemisinin resistance has been reported in some countries and regions, making malaria prevention and control increasingly challenging 5.
- Understanding the mechanisms of antimalarial resistance is crucial for the development of novel antimalarials and the rational application of existing antimalarials to avoid the spread of resistance 5.
Emerging Roles of Artemisinin
- Artemisinin and its derivatives have been shown to have anti-viral, anti-inflammatory, and anti-cancer effects, and may have a potential role in the treatment of liver diseases 6.
- Further research is needed to determine the therapeutic potential of artemisinin and its derivatives in liver disease treatment 6.