Artesunate
IV artesunate is first-line for severe falciparum malaria in adults and children. Seek specialist advice early (e.g. very high parasite count, deterioration on treatment, or infection acquired in areas of artemisinin resistance).
Mode of action
- Mortality from untreated severe malaria (particularly cerebral malaria) approaches 100%.
- With prompt, effective antimalarial treatment and supportive care, the rate falls to 10-20% overall.
Indications/Dose Severe Falciparum Malaria
- IV artesunate is first line (WHO; UK guidance). Use IV quinine only if artesunate is not immediately available. Take expert help.
- Artesunate 2.4 mg/kg IV at 0, 12 and 24 h. Repeat daily until blood film clear.
Dose range:You must check with BNF or drug datasheet
| Name | Dose | Frequency | Route |
|---|
| Artesunate | 2.4 mg/kg | stat at 0 hrs | IV |
| Artesunate | 2.4 mg/kg | stat at 12 hrs | IV |
| Artesunate | 2.4 mg/kg | stat at 24 hrs | IV |
💊 Artesunate IV/IM Dosing by Weight (Severe Malaria)
Dose repeated at 0 h, 12 h, 24 h, then daily until oral therapy can be given.
Under 20 kg → 3 mg/kg
| 20 kg and over → 2.4 mg/kg
⚗️ Preparation & Administration
- Vial strength: 60 mg powder (artesunate) per vial.
- Reconstitution: Add 1 mL of 5% sodium bicarbonate → forms sodium artesunate solution.
- Then add 5 mL of 5% dextrose or normal saline to make a final concentration of 10 mg/mL.
- Inspect: Solution should be clear; discard if discoloured or precipitated.
- Stability: Use immediately after reconstitution - do not store for later use.
💉 Administration
- IV route (preferred): Inject slowly over 1–2 minutes into a vein.
- IM route: If IV access is not possible, inject deep into the anterolateral thigh (alternate sides if multiple doses).
- Repeat doses: at 0 h, 12 h, 24 h, then once daily until oral therapy can begin.
🔄 Transition to Oral Therapy
- Once the patient can tolerate oral medication, switch to a full course of an artemisinin-based combination therapy (ACT), e.g. artemether–lumefantrine.
- Give ACT as soon as the patient can swallow, typically after 24–48 hours of parenteral therapy.
⚠️ Key Safety Notes
- Under 20 kg: use 3 mg/kg per dose (WHO).
- 20 kg and over: use 2.4 mg/kg per dose.
- Continue supportive care - monitor for hypoglycaemia, anaemia, and delayed haemolysis (may appear 1–3 weeks post-treatment).
- Always verify dose accuracy and reconstitution locally before administration.
📘 Based on WHO Malaria Guidelines (2023) and BNF for Children. For educational use only - confirm all doses and preparation details in your local protocol before use.
📘 Based on WHO (2023) and BNF guidance. For educational use only - always verify dose and preparation locally before administration.
Interactions
Cautions
Contraindications
Side effects
- See BNF
- Skin rash, Nausea, vomiting, anorexia, and dizziness which may actually be due to malaria
- Generally well-tolerated. Cardiotoxicity (high doses) Long QT, Bradycardia
- Neurotoxicity observed in animal studies, Drug-induced fever
- Hypoglycemia will be less common when artesunate is used rather than quinine or quinidine;
References
