Intravenous Artesunate for Imported Severe Malaria in Children Treated in Four Tertiary Care Centers in Germany: A Retrospective Study

Pediatr Infect Dis J. 2019 Nov;38(11):e295-e300. doi: 10.1097/INF.0000000000002417.


Background: Intravenous artesunate (ivA) is the standard treatment for severe malaria. Data systematically evaluating the use of ivA in pediatric patients outside malaria-endemic regions are limited. The aim of this case series was to summarize efficacy and safety of ivA for imported severe malaria in children in Germany.

Methods: Our retrospective case series included pediatric patients with imported severe malaria treated with at least 1 dose of ivA (Artesun, Guilin Pharmaceutical; Shanghai, China) at 4 German tertiary care centers. Severe malaria was defined according to World Health Organization criteria.

Results: Between 2010 and 2018, 14 children with a median [interquartile range (IQR)] age of 6 (1;9.5) years were included. All children were of African descent. All but 2 patients had Plasmodium falciparum malaria; 1 child had P. vivax malaria and 1 child had P. falciparum and P. vivax co-infection. Median (IQR) parasitemia at admission in patients with P. falciparum was 9.5% (3;16.5). Patients were treated with 1-10 [median (IQR) 3 (3;4)] doses ivA. All but one patient received a full course of oral antimalarial treatment. Parasite clearance was achieved within 2-4 days, with the exception of 1 patient with prolonged clearance of peripheral parasitemia. Three patients experienced posttreatment hemolysis but none needed blood transfusion. Otherwise ivA was safe and well tolerated.

Conclusions: ivA was highly efficacious in this pediatric cohort. We observed episodes of mild to moderate posttreatment hemolysis in approximately one-third of patients. The legal status and usage of potentially lifesaving ivA should be evaluated in Europe.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease / therapy
  • Administration, Intravenous
  • Adolescent
  • Antimalarials / administration & dosage
  • Antimalarials / therapeutic use*
  • Artesunate / administration & dosage
  • Artesunate / therapeutic use*
  • Child
  • Child, Preschool
  • Communicable Diseases, Imported / drug therapy
  • Communicable Diseases, Imported / parasitology
  • Female
  • Germany
  • Humans
  • Infant
  • Malaria, Falciparum / drug therapy*
  • Malaria, Vivax / drug therapy*
  • Male
  • Parasitemia / drug therapy
  • Retrospective Studies
  • Tertiary Care Centers


  • Antimalarials
  • Artesunate