The updated ‘National Malaria Treatment Guidelines 2017’ (final draft version) can be accessed on the NICD website (www.nicd.ac.za).

In these guidelines, artesunate replaces quinine as the treatment of choice for severe malaria. Compared to parenteral quinine, artesunate reduces death from severe malaria by 39% in adults and 24% in children.

Its advantages include:

1. Rapid antimalarial action with activity against early to late stages of the parasite life cycle, thus preventing sequestration of parasite-infected red cells, and attendant complications
2. Administration as a slow intravenous injection over several minutes rather than a slow rate-controlled intravenous infusion over 4-6 hours
3. A favourable safety profile and without causing hypoglycaemia
4. Not requiring dosage adjustment in renal failure
5. Artesunate can be used in all trimesters of pregnancy (see malaria guidelines for discussion)
6. There is no lower age or weight limit
7. It can be administered intramuscularly if intravenous administration not possible.

The dosage of artesunate is 2.4mg/kg for patients weighing >20kg stat, and again at 12 and 24 hours, and then once daily until patients can take oral treatment. For patients weighing <20kg, the dose is 3mg/kg stat following the same schedule.

Artesunate must be given for at least 24 hours (i.e. 3 doses), and should be followed by a full course of artemether-lumefantrine (Coartem®) to avoid recrudescence.

Further details on administration can be found here.

Source: Division of Public Health Surveillance and Response, NICD-NHLS (lucilleb@nicd.ac.za); Amayeza Information Centre; Department of Clinical Pharmacology, University of Cape Town