Treatment outcome of intravenous artesunate in patients with severe malaria in the Netherlands and Belgium

Malar J. 2012 Mar 31;11:102. doi: 10.1186/1475-2875-11-102.

Abstract

Background: Intravenous (IV) artesunate is the treatment of choice for severe malaria. In Europe, however, no GMP-manufactured product is available and treatment data in European travellers are scarce. Fortunately, artesunate became available in the Netherlands and Belgium through a named patient programme. This is the largest case series of artesunate treated patients with severe malaria in Europe.

Methods: Hospitalized patients treated with IV artesunate between November 2007 and December 2010 in the Netherlands and Belgium were retrospectively evaluated. Patient characteristics, treatment and clinical outcome were recorded on a standardized form and mortality, parasite clearance times and the occurrence of adverse events were evaluated.

Results: Of the 68 treated patients, including 55 with severe malaria, two patients died (2/55 = 3.6%). The mean time to 50% parasite clearance (PCT50), 90% and 99% were 4.4 hours (3.9 - 5.2), 14.8 hours (13.0 - 17.2), and 29.5 hours (25.9 - 34.4) respectively. Artesunate was well tolerated. However, an unusual form of haemolytic anaemia was observed in seven patients. The relationship with artesunate remains uncertain.

Conclusions: Data from the named patient programme demonstrate that IV artesunate is effective and well-tolerated in European travellers lacking immunity. However, increased attention needs to be paid to the possible development of haemolytic anaemia 2-3 weeks after start of treatment.Treatment of IV artesunate should be limited to the period that IV treatment is required and should be followed by a full oral course of an appropriate anti-malarial drug.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antimalarials / administration & dosage*
  • Antimalarials / adverse effects
  • Artemisinins / administration & dosage*
  • Artemisinins / adverse effects
  • Artesunate
  • Belgium
  • Female
  • Humans
  • Infusions, Intravenous
  • Malaria / drug therapy*
  • Malaria / mortality
  • Male
  • Middle Aged
  • Netherlands
  • Retrospective Studies
  • Travel
  • Treatment Outcome
  • Young Adult

Substances

  • Antimalarials
  • Artemisinins
  • Artesunate