Artesunate Should Become the Treatment of Choice for Severe Malaria

Artesunate is better than quinine for the treatment of severe malaria in adults, concludes an article in this weeks issue of The Lancet.

Quinine is the only drug recommended for the treatment of severe malaria throughout Africa, South America, and most of Asia. But even with prompt administration of the drug in maximum doses mortality from severe malaria remains high. Intravenous artesunate is more rapidly acting, in terms of parasite clearance, is safer, and is simpler to administer than intravenous quinine. However, whether the drug could reduce mortality was unclear.

Nick White, part of the faculty of the tropical medicine department at Mahidol University in Bangkok, Thailand, and colleagues recruited 1,461 patients with severe malaria from Bangladesh, Indonesia, India, and Myanmar into a randomized controlled trial comparing artesunate with quinine. Half the patients were assigned intravenous artesunate and half intravenous quinine. The investigators found that mortality from severe malaria was 15 percent in artesunate recipients compared with 22 percent in quinine recipients.

White concludes, Our findings in this large multi-center trial show that parenteral artesunate reduces mortality in patients with severe malaria by over a third compared with quinine Unfortunately, despite 20 years of use in east Asia, there is still no generally available formulation of parenteral artesunate made to good manufacturing practices standards. Quality assured, affordable parenteral artesunate should be made widely available in malaria endemic areas as a matter of urgency.

Source: The Lancet