From the Guidelines
Yes, artesunate can be given to a patient with high-grade fever, chills, headache, and vomiting in a malarious area even if the peripheral smear is negative for malaria parasites. This approach is supported by the most recent evidence from 2024, which emphasizes the importance of prompt treatment in high-risk settings 1. The typical adult dosage of artesunate is 2.4 mg/kg body weight given intravenously or intramuscularly at 0,12, and 24 hours, then once daily until oral therapy can be started, as recommended for severe malaria treatment 1. Key points to consider when administering artesunate include:
- Monitoring for clinical complications of severe malaria and managing them according to guidelines 1
- Switching to an artemisinin-based combination therapy (ACT) once the patient is clinically improved and able to take oral treatment 1
- Continuing to investigate for other causes of fever while treating for malaria The rationale for presumptive treatment is that malaria can rapidly progress to severe disease and death within hours, and peripheral smears may be falsely negative, particularly if the patient has taken antimalarials previously or if the parasitemia is below the detection threshold 1. Early treatment saves lives, and the benefits of prompt treatment outweigh the risks of unnecessary medication in these high-risk settings. It is also crucial to follow the patient's response to treatment, including monitoring parasitaemia levels, as outlined in the management of complicated and uncomplicated malaria 1.
From the Research
Administration of Artesunate in Malarious Areas
- Artesunate can be given to a patient with high-grade fever, chills, headache, and vomiting in a malarious area, even if the peripheral smear is negative for malaria parasites, as the symptoms presented are consistent with severe malaria 2, 3.
- The World Health Organization recommends artesunate as the first-line treatment for severe malaria, and it has been shown to be more effective than quinine in reducing mortality 2.
- In areas where malaria is endemic, it is crucial to consider malaria as a potential cause of fever, even if the initial diagnostic tests are negative, due to the high risk of mortality associated with delayed treatment 3, 4.
Efficacy and Safety of Artesunate
- Artesunate has been shown to be highly effective in clearing parasites and resolving symptoms in patients with severe malaria, with a rapid reduction in parasitemia levels and improvement in clinical condition 2, 4, 5.
- The safety profile of artesunate is generally favorable, with few reported adverse events, although cases of post-treatment hemolysis have been observed, particularly in patients with high parasitemia levels 6, 5.
- Monitoring for signs of hemolysis is essential, especially after parasitologic cure, and extended follow-up may be necessary to detect potential complications 6, 5.
Treatment Guidelines
- The decision to administer artesunate should be based on clinical judgment, taking into account the patient's symptoms, medical history, and the epidemiological context of the area 2, 3.
- In cases where malaria is suspected, but the peripheral smear is negative, artesunate may still be considered as a treatment option, given the potential for false-negative results and the high risk of mortality associated with delayed treatment 3, 4.