What is the recommended dose of artesunate (intravenous or intramuscular) for a 10kg child with confirmed malaria?

From the Guidelines

For a 10kg child with confirmed malaria, the recommended dose of artesunate is 2.4 mg/kg per dose, which equals 24 mg per dose, administered intravenously or intramuscularly at 0,12, and 24 hours, then once daily until oral therapy can be started, as supported by the most recent study 1. This dosing regimen is effective because artesunate rapidly reduces parasite burden by targeting all stages of the parasite lifecycle, making it particularly valuable for severe malaria where quick reduction of parasite load is critical for improving outcomes. When administering, the artesunate powder should be reconstituted with the provided sodium bicarbonate solution, then diluted with normal saline or 5% dextrose if given IV. For IM administration, use the smaller volume of diluent as specified in the product instructions. Monitor the child for clinical improvement, including fever resolution and parasite clearance, and check parasitaemia every 12 hours until a decline (<1%) is detected and then every 24 hours until negative, as recommended 1. Additionally, full blood count, hepatic, kidney, and metabolic exams (glycaemia and blood gas analysis) should be done every day to detect improvement, and monitoring of delayed haemolysis on days 7,14,21, and 28 is necessary 1. It is also important to note that oral ACT therapy, if feasible, should be started following 3 doses of artesunate and when parasite level is <1% 1. Some key points to consider in the management of malaria include:

• The use of artesunate as the preferred treatment for severe malaria 1
• The importance of monitoring for clinical improvement and potential adverse effects, such as delayed haemolysis 1
• The need for careful consideration of the treatment regimen, including the use of oral ACT therapy when feasible 1

From the Research

Recommended Dose of Artesunate for a 10kg Child with Confirmed Malaria

• The World Health Organization recommends individual doses of 3 mg/kg for children weighing < 20 kg with severe falciparum malaria 2.
• A study published in 2021 suggests that a single dose of rectal artesunate (10 mg/kg of body weight) can be effective in treating severe falciparum malaria in children 3.
• However, for intravenous artesunate, a study published in 2023 recommends a dose of 3 mg/kg for children, including those weighing less than 20 kg, as a lower dose of 2.4 mg/kg may not provide adequate drug exposure 2.
• Another study published in 2012 evaluated the pharmacokinetics of intravenous artesunate at doses of 2,4, and 8 mg/kg in healthy volunteers, but did not provide specific recommendations for children 4.

Calculation of Recommended Dose for a 10kg Child

• Based on the recommended dose of 3 mg/kg, the calculated dose for a 10kg child would be 10kg x 3mg/kg = 30mg.
• It is essential to note that the dose should be administered by a healthcare professional, and the treatment should be part of a comprehensive management plan for malaria.

Important Considerations

• The treatment of malaria, especially in children, requires careful consideration of the severity of the disease, the patient's weight, and the potential for drug interactions 5, 3, 2.
• Healthcare professionals should consult the latest guidelines and recommendations from reputable sources, such as the World Health Organization, when treating malaria in children.