From the Guidelines
Artesunate is recommended to be dosed at 2.4 mg/kg intravenously at 0,12, and 24 hours, then continue with 2.4 mg/kg daily for 7 days, as the preferred treatment for complicated malaria, as stated in the most recent study 1. This dosing regimen is crucial for effectively treating severe malaria, and it is essential to initiate treatment as soon as possible after diagnosis to minimize mortality risk. The treatment should continue for a minimum of 24 hours until oral therapy can be tolerated, at which point patients should complete a full course of artemisinin-based combination therapy (ACT) such as artemether-lumefantrine. Some key points to consider when administering artesunate include:
- Monitoring for potential adverse reactions, such as haemoglobinuria and post-artesunate delayed haemolysis (PADH) 1
- Adjusting the dosing regimen for patients with renal or hepatic impairment
- Considering alternative treatments, such as quinine or atovaquone-proguanil, for patients who are unable to tolerate artesunate or have a contraindication to its use 1 It is also important to note that artesunate works rapidly by creating free radicals that damage parasite proteins, making it particularly effective for severe malaria where quick reduction of parasite load is critical. Overall, the use of artesunate as a first-line treatment for severe malaria is supported by the most recent and highest-quality evidence, and it is essential to follow the recommended dosing regimen to ensure optimal treatment outcomes.
From the Research
Recommended Dose of Artesunate
The recommended dose of Artesunate varies depending on the formulation and the patient's condition.
- For intravenous artesunate, a dose of 2.4 mg/kg at 0,12, and 24 hours, then daily, has been used in the treatment of severe Plasmodium falciparum malaria 2.
- A simplified regimen of intravenous artesunate, consisting of 3 doses given at 0,24, and 48 hours, has been shown to be non-inferior to a conventional 5-dose regimen in African children with severe malaria 3.
- For rectal artesunate, a single dose of about 10 mg/kg has been used in the initial management of moderately severe falciparum malaria 4.
- The World Health Organization (WHO) recommends a single intramuscular dose of intramuscular artesunate, or intramuscular artemether, or intramuscular quinine, in that order of preference, as pre-referral treatment when definitive treatment is not possible 5.