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.
- Mosquito netting treated with insecticides
- Spraying insecticides indoors once or twice per year
- Insect repellant
- Medication to prevent malaria
Symptoms of Malaria
Malaria symptoms may include the following (not all-inclusive):
- Flu-like symptoms (fever, chills, muscle aches)
- Nausea and vomiting
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
- Kidney and liver dysfunction
- Abnormal bleeding
- Multi-organ failure
Once malaria progresses from mild to severe, it becomes life-threatening.
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.
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!
- World Health Organization. Malaria. Available from: https://www.who.int/malaria/en/. Accessed 13 Jul 2020.
- Centers for Disease Control and Prevention. Malaria. Available from: https://www.cdc.gov/parasites/malaria/index.html. Updated 24 Apr 2020. Accessed 13 Jul 2020.
- U.S. Food and Drug Administration. FDA Approves Only Drug in U.S. to Treat Severe Malaria. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-only-drug-us-treat-severe-malaria. Published 26 May 2020. Accessed 13 Jul 2020.
- World Health Organization. Malaria Fact Sheet. Available from: https://www.who.int/news-room/fact-sheets/detail/malaria. Updated 14 Jan 2020. Accessed 13 Jul 2020.
- White NJ, Hien TT, Nosten FH. A Brief History of Qinghaosu. Trends Parasitol. 2015;31(12):607-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674626/
- Sinclair D, Donegan S, Isba R, Lalloo DG. Artesunate versus quinine for treating severe malaria. Cochrane Database Syst Rev. 2012;2012(6):CD005967. Published 2012 Jun 13. Available from: https://pubmed.ncbi.nlm.nih.gov/22696354/
- Centers for Disease Control and Prevention. Malaria Treatment (United States). Available from: https://www.cdc.gov/malaria/diagnosis_treatment/treatment.html. Updated 7 May 2020. Accessed 13 Jul 2020.
- Centers for Disease Control and Prevention. Intravenous Artesunate for Treatment of Severe Malaria in the United States. Available from: https://www.cdc.gov/malaria/diagnosis_treatment/artesunate.html. Updated 10 Jun 2020. Accessed 13 Jul 2020.