IV Artesunate Administration Protocol for Severe Malaria
IV artesunate should be administered at a dose of 2.4 mg/kg at 0,12, and 24 hours, then daily thereafter, until parasitemia is <1% and the patient can take oral medication. 1
Dosing and Administration
- Initial dose: 2.4 mg/kg body weight
- Timing: Administer at 0,12, and 24 hours, then once daily
- Duration: Continue until:
- Parasitemia decreases to <1% AND
- Patient can tolerate oral medication
- Route: Intravenous (IV) bolus
Monitoring During Treatment
- Check parasitemia every 12 hours until <1%, then every 24 hours until negative 1
- Monitor daily:
- Complete blood count
- Liver function tests
- Kidney function
- Metabolic parameters 1
- Blood glucose monitoring (hypoglycemia is a common complication)
- Electrolytes, particularly potassium levels
Practical Administration Considerations
- IV artesunate is more rapidly acting than quinine in terms of parasite clearance 2
- The large inter-individual variability in drug levels supports 2.4 mg/kg as the minimum dose 3
- If IV artesunate is unavailable, IV quinine can be used as an alternative (20 mg/kg loading dose over 4 hours, then 10 mg/kg every 8 hours) 1
Follow-up Treatment
- Switch to oral antimalarial medication as soon as the patient can tolerate it
- Complete a full course of an appropriate oral antimalarial drug 4
- Options for oral therapy include:
- Artemether-Lumefantrine
- Dihydroartemisinin-Piperaquine
- Atovaquone-Proguanil 1
Special Considerations
- Fluid management: Use restrictive fluid management to avoid pulmonary or cerebral edema 1
- Hypoglycemia: Treat with 5 mL/kg of 10% dextrose if detected 1
- Pregnant women: IV artesunate can be administered with careful monitoring 1
- Children: Use the same medication with weight-adjusted dosing 1
Potential Adverse Effects
- Generally well-tolerated compared to quinine 2
- Watch for delayed hemolytic anemia, which may occur 2-3 weeks after treatment initiation 4
- Consider acetaminophen (1g every 6 hours) for potential renoprotective effects 1
Common Pitfalls to Avoid
- Delaying treatment (severe malaria is a medical emergency)
- Underdosing (ensure minimum dose of 2.4 mg/kg)
- Premature discontinuation of IV therapy before parasitemia is <1%
- Failure to transition to appropriate oral therapy
- Inadequate monitoring for complications (hypoglycemia, electrolyte disturbances)
- Not monitoring for delayed hemolytic anemia after treatment
IV artesunate has demonstrated superior efficacy and safety compared to quinine, with mortality reduction of 34.7% in clinical trials 2, making it the treatment of choice for severe malaria.