From the Guidelines
For a 4-year-old male with malaria who is positive on artesunate testing and presenting with fever and convulsions, immediate treatment with intravenous artesunate is recommended at a dose of 2.4 mg/kg given at 0,12,24 hours, and then once daily until oral therapy can be tolerated. This child requires hospital admission for severe malaria management. After the child stabilizes and can take oral medications, complete the treatment with a full course of artemisinin-based combination therapy (ACT) such as artemether-lumefantrine for 3 days 1. The convulsions should be managed with appropriate anticonvulsants like diazepam 0.3 mg/kg IV or rectal diazepam 0.5 mg/kg if IV access is difficult. Fever should be controlled with paracetamol 15 mg/kg every 6 hours. Supportive care including fluid management, blood glucose monitoring, and treatment of any concurrent infections is essential. The child should be monitored for complications of severe malaria including cerebral malaria, severe anemia, hypoglycemia, and metabolic acidosis. Parenteral artesunate is the first-line treatment for severe malaria as it rapidly reduces parasite load and has been shown to reduce mortality compared to other antimalarials in children with severe malaria.
Some key points to consider in the management of this patient include:
- Monitoring of parasitaemia every 12 hours until a decline to <1% is observed and then every 24 hours till a negative result is observed 1.
- Monitoring for post-artesunate delayed haemolysis (PADH) on days 7,14,21, and 28 1.
- The use of anticonvulsants and antipyretics as needed to manage symptoms.
- The importance of supportive care, including fluid management and blood glucose monitoring, to prevent and manage complications of severe malaria.
It is also important to note that the treatment of malaria in children requires careful consideration of the child's age, weight, and clinical condition, as well as the potential for drug interactions and side effects 1. Therefore, treatment should be guided by the most recent and highest-quality evidence, and should be individualized to the specific needs of the patient.
From the Research
Treatment for Malaria with Fever and Convulsions
- The treatment for a 4-year-old male with malaria, positive on artesunate, presenting with fever and convulsions involves the use of parenteral antimalarial drugs, with artesunate being the first-line treatment for severe malaria in adults and children 2.
- According to the World Health Organization (WHO), artesunate has shown a reduction in mortality rate in severe malaria 2.
- In cases of cerebral malaria, intranasal administration of artesunate has been tested and shown to dramatically reduce mortality rate, preventing death in most cases, and decreasing parasitaemia loads by 88.7% within 24 hours after administration 3.
- For children with severe malaria, a population pharmacokinetic study of intramuscular artesunate was conducted, and an adapted dosing regimen including a practical dosing table per weight band is proposed for young children based on the pharmacokinetic model 4.
- It is essential to note that artesunate can cause side effects, such as delayed post-artesunate haemolytic anemia (PADH), and close monitoring is necessary, especially in children 2, 5.
Administration and Monitoring
- The administration of artesunate should be done under close monitoring, especially in pediatric patients, to prevent and manage potential side effects 2, 4.
- In cases of severe malaria with fever and convulsions, it is crucial to activate a strategic network to obtain and administer intravenous artesunate promptly 6.
- The patient's condition should be closely monitored, and laboratory studies should be conducted to assess the response to treatment and potential side effects 6, 5.