Intravenous Artesunate for Severe Malaria in Travelers, Europe

Abstract

Multicenter trials in Southeast Asia have shown better survival rates among patients with severe malaria, particularly those with high parasitemia levels, treated with intravenous (IV) artesunate than among those treated with quinine. In Europe, quinine is still the primary treatment for severe malaria. We conducted a retrospective analysis for 25 travelers with severe malaria who returned from malaria-endemic regions and were treated at 7 centers in Europe. All patients survived. Treatment with IV artesunate rapidly reduced parasitemia levels. In 6 patients at 5 treatment centers, a self-limiting episode of unexplained hemolysis occurred after reduction of parasitemia levels. Five patients required a blood transfusion. Patients with posttreatment hemolysis had received higher doses of IV artesunate than patients without hemolysis. IV artesunate was an effective alternative to quinine for treatment of malaria patients in Europe. Patients should be monitored for signs of hemolysis, especially after parasitologic cure.

Intravenous artesunate versus intravenous quinine in the treatment of severe falciparum malaria: a retrospective evaluation from a UK centre

“…Six cases of late-onset haemolysis after AS were reported by Zoller et al among 25 travellers from seven treatment centres in Europe. 27 In those cases, haemolysis was diagnosed ,15 days after the first dose of AS; in two cases, Coombs tests were performed, and both were negative. In our patient, G6PD deficiency was excluded, but the Coombs test was positive, indicating immune-mediated haemolysis.…”

“…We found a reduced length of stay in patients receiving AS, compared to patients treated with Q, a finding not previously documented. [27][28][29] We consider LOS is an important proxy for faster clinical recovery. The only studies looking at length of stay come from the developing world and found no reduction, which may be related to resource constraints or similar factors.…”

“…4,5 It remains an unlicensed drug, with its formulation not having met good manufacturing practice (GMP). 4,26,27 Furthermore, there are few data from centres in developed countries regarding safety and efficacy of AS in severe imported malaria. [27][28][29] At Northwick Park Hospital, we changed from Q to AS in the treatment of severe FM in June 2009; we undertook a retrospective evaluation of our experience with both drugs.…”

Antiviral Effects of Artesunate on Polyomavirus BK Replication in Primary Human Kidney Cells

“…For instance, the effect on host cells was investigated by measuring residual cell layers by the LDH assay at 4 or 7 days after artesunate addition to confluent cells (17,51) or by measuring the LDH release in the supernatant 7 days after artesunate addition (18). Although short-term artesunate treatment is considered safe, there have been some reports on hemolytic anemia after treatment of severe malaria, but this may actually be a consequence of the severe malaria and not of artesunate (52). Even though the cytostatic effects will probably not afflict the slowly cycling epithelial cells of healthy kidneys or the urinary bladder, it may jeopardize the regeneration of epithelium damaged by PyVAN or PyVHC.…”

Postartesunate delayed hemolysis is a predictable event related to the lifesaving effect of artemisinins

“…1 Compared with quinine, AS further reduces mortality resulting from severe malaria by 22.5% to 35% 2,3 and induces fewer adverse cardiac events or hypoglycemic episodes. [2][3][4][5] However, delayed anemic episodes were recently reported in 20% to 25% of travelers with severe malaria treated with AS, [6][7][8][9][10][11][12] a high, and possibly overestimated, proportion. All of these patients survived, but 60% of them required transfusions.…”