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Fact Checked

Artesunate: A Lifesaving Medication for Severe Malaria

Malaria is a major global issue, and although it is not as common in the U.S., there are still about 2,000 cases per year. According to the World Health Organization (WHO), in 2018, there were approximately 228 million cases worldwide, with just over 400,000 deaths. Most of the deaths were children under the age of 5 years old in Africa. People at the highest risk of dying from malaria are pregnant women, children under the age of 5, and those who travel from a country without malaria (like the United States) to a country with malaria (like Africa).

Malaria is a disease caused by a parasite transferred to humans, most commonly through mosquito bites. Malaria needs to be treated as quickly as possible once it is identified to prevent complications and death. Of the 2,000 cases per year in the U.S., about 300 cases are considered severe. Artesunate is a medication that was recently approved for the treatment of severe malaria by the U.S. Food and Drug Administration (FDA). Since severe malaria is life-threatening, the approval and use of artesunate will save lives.

Where and How People Become Infected with Malaria

Malaria is most commonly found in Africa, south of the Sahara. The Center for Disease Control and Prevention (CDC) publishes and regularly updates a list of all countries affected, which is important to review while making travel plans. 

Anyone can become infected with malaria, but malaria is not contagious through close contact with others. The parasites that cause malaria are transferred by blood, most commonly via mosquito bites. The female Anopheles mosquito is the only kind that can infect people with malaria. Malaria can also be spread via infected blood, such as sharing contaminated syringes, blood transfusions, or from a mother to baby during pregnancy or delivery. 

Preventing Malaria

The best way to prevent spreading malaria is to avoid getting bit by mosquitos when in areas with malaria. According to the WHO and the CDC, prevention methods include:

  • Mosquito netting treated with insecticides
  • Spraying insecticides indoors once or twice per year
  • Insect repellant
  • Medication to prevent malaria

There is no malaria vaccine currently on the market in the U.S.; however, there is a promising vaccine being tested in certain parts of Africa. 

Symptoms of Malaria 

Malaria symptoms may include the following (not all-inclusive):

  • Flu-like symptoms (fever, chills, muscle aches)
  • Fatigue
  • Nausea and vomiting
  • Diarrhea

It is crucial to identify malaria early in the course of the illness because a mild case left untreated can become severe very quickly, often within 24 hours.  Severe cases in children usually include breathing difficulties and low red blood cells (anemia), while severe cases in adults may result in the following symptoms:

  • Severe anemia
  • Seizures
  • Coma
  • Shock
  • Kidney and liver dysfunction
  • Abnormal bleeding
  • Multi-organ failure

Once malaria progresses from mild to severe, it becomes life-threatening. 

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Treating Severe Malaria with Artesunate

Artesunate is not a new medication; in fact, it has been studied as an antimalarial agent since the 1990s. Quinine was the preferred treatment for severe malaria, but when quinine and artesunate were compared in clinical trials, artesunate was safer and prevented more deaths than quinine. 

Based on the trial data, artesunate reduces the risk of death by nearly 40% in adults and 25% in children. Of note, quinine is no longer widely available in the U.S.; however, it is still used globally. 

There are several options for treating mild cases of malaria, but the best treatment option for severe cases is artesunate. It is an antimalarial medication that stops the growth of the parasite and makes it harder for the parasite to live. Artesunate is the only medication currently approved to treat severe malaria in the U.S.; this approval allows for manufacturing and easier access. 

According to the CDC, treatment should begin immediately with artesunate in patients with severe malaria. Artesunate is given intravenously (through the veins) three times – the first dose is given, then another one at 12 hours and the final dose at 24 hours. Following the three doses of artesunate, patients should continue treatment with either an oral medication or more artesunate if they are unable to swallow pills. 

Artesunate can be used safely in women who are pregnant, as well as in infants and children, and it does not typically cause side effects. Rarely, it may worsen anemia, so blood draws are usually required for a few weeks after treatment. 

Take-Home Points

Malaria is prevalent in Africa and several other countries in the world. Many prevention options exist; however, treatment options are more limited, especially when treating severe malaria. Artesunate is the only medication available and approved in the U.S. to treat severe malaria. Once severe malaria is identified, providing artesunate as soon as possible saves lives. 

Take note - just because artesunate is approved and is proven to work well does not mean you should feel comfortable with the risks of getting infected with malaria. Therefore, if you plan to travel to an area with malaria, make sure you consult your doctor about malaria prevention so you won’t need artesunate!

Reference List

Published July 30th, 2020 by Dr. Sara Fisher, PharmD
Fact Checked by Chris Riley

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