From the Guidelines
The recommended treatment for severe malaria is intravenous artesunate, as it is the most effective treatment in reducing mortality and improving outcomes, as shown in recent studies 1.
Key Considerations
- Intravenous artesunate should be administered for 3 doses, and once the patient is clinically improved and able to take oral treatment, a switch to one of the available artemisinin-based combination therapies (ACTs) should be done, with the administration of a full course of the chosen drug 1.
- Clinical complications of severe malaria, such as severe anemia, hypoglycemia, acute kidney injury, and respiratory distress, should be managed by intensivists according to guidelines and recent achievements 1.
- Restrictive fluid management is generally adopted to avoid pulmonary or cerebral edema, and acetaminophen may be used to reduce the risk of acute kidney injury 1.
Monitoring and Follow-up
- Patients with severe malaria should be closely monitored in an intensive care setting, with continuous monitoring of cardiocirculatory, pulmonary, kidney, and metabolic parameters 1.
- Monitoring of peripheral blood parasitemia should be done every 12 hours after starting treatment until a decline to <1% is observed, and then every 24 hours till a negative result is observed 1.
Alternative Treatments
- In settings where artesunate is unavailable, intravenous quinine or quinidine can be used as alternatives, though they have more side effects, including cardiac arrhythmias and hypoglycemia 1.
- However, artesunate is the preferred treatment due to its higher efficacy and safety profile, as demonstrated in recent studies 1.
From the Research
Diagnosis and Treatment of Severe Malaria
- Severe malaria is a medical emergency that requires prompt treatment with effective anti-malarial drugs 2, 3, 4, 5, 6.
- The diagnosis of severe malaria is based on the presence of vital organ involvement, including shock, pulmonary edema, significant bleeding, seizures, impaired consciousness, and laboratory abnormalities such as kidney impairment, acidosis, anemia, or high parasitemia 3.
Recommended Treatment for Severe Malaria
- Intravenous artesunate is the first-line therapy for severe malaria 2, 3, 4, 5.
- Artesunate has been shown to be more effective than quinine in reducing mortality from severe malaria 2.
- The recommended dose of artesunate is 2.4 mg/kg bodyweight given as a bolus at 0,12, and 24 h, and then daily 2.
- Intramuscular artesunate is also effective and can be used in remote health facilities where intravenous administration is not possible 6.
Pharmacokinetics and Pharmacodynamics of Artesunate
- Artesunate is rapidly absorbed and achieves therapeutic concentrations quickly 5.
- The terminal elimination half-life of artesunate is short, ranging from 0.1 to 1.8 hours 5.
- Dihydroartemisinin, the active metabolite of artesunate, also achieves therapeutic concentrations quickly and has a longer half-life than artesunate 5.