What is the proper procedure for infusing intravenous (IV) artesunate?

IV Artesunate Infusion Procedure

IV artesunate should be administered at a dose of 2.4 mg/kg at 0,12, and 24 hours, then daily, until parasitemia is <1% and the patient can take oral medication. 1

Preparation and Administration

1. Reconstitution:

   • Artesunate powder should be reconstituted in 5% dextrose solution
   • Ensure complete dissolution before administration

2. Dosing Schedule:

   • First dose: 2.4 mg/kg at hour 0
   • Second dose: 2.4 mg/kg at hour 12
   • Third dose: 2.4 mg/kg at hour 24
   • Subsequent doses: 2.4 mg/kg once daily

3. Administration Method:

   • Administer as a slow IV bolus injection
   • Alternative: IV infusion over 2-4 hours (for improved stability)

Stability Considerations

Artesunate has limited stability at room temperature, which is a critical consideration when preparing the medication:

• At 23°C (room temperature): Stable for approximately 10.6 hours 2
• At 30°C (tropical conditions): Stable for approximately 4 hours 2
• At 36.5°C (body temperature): Stable for only 1.6 hours 2

Therefore, freshly prepare the solution shortly before administration and do not store reconstituted solution for extended periods.

Monitoring During Treatment

• Check parasitemia every 12 hours until <1%, then every 24 hours until negative 1
• Monitor complete blood count, liver function, kidney function, and metabolic parameters daily 1
• Watch for post-artesunate delayed hemolysis (PADH), a known complication 3
• Monitor glucose levels regularly as hypoglycemia can occur 1

Duration of IV Treatment

Continue IV artesunate until:

1. Parasitemia is <1% AND
2. Patient can tolerate oral medication

Then switch to a complete course of oral antimalarial therapy (artemether-lumefantrine, dihydroartemisinin-piperaquine, or atovaquone-proguanil) 1.

Special Considerations

• Artesunate is preferred over quinine for severe malaria due to:

  • More rapid parasite clearance
  • Lower mortality (15% vs 22%) 4
  • Better safety profile with fewer side effects 4
  • Simpler administration 4

• If IV artesunate is unavailable, IV quinine is the alternative (loading dose 20 mg salt/kg over 4 hours, then 10 mg salt/kg every 8 hours) 1

• Artesunate can be safely administered with hydroxyurea in patients with conditions such as sickle cell disease 1

The rapid action of artesunate makes it the drug of choice for severe malaria, with its ability to quickly reduce parasite load and improve clinical outcomes compared to traditional treatments like quinine.