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

A.R. Kreeftmeijer-Vegter, P.J. van Genderen, L.G. Visser, W.F. Bierman, J. Clerinx, C.K. van Veldhuizen, P.J. de Vries

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    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 haemolyticanaemia 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 haemolyticanaemia 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.
    Original languageEnglish
    JournalMalaria Journal
    Volume11
    Issue number102
    Pages (from-to)1-11
    Number of pages11
    ISSN1475-2875
    DOIs
    Publication statusPublished - 2012

    Keywords

    • Protozoal diseases
    • Malaria
    • Plasmodium falciparum
    • Vectors
    • Mosquitoes
    • Anopheles
    • Severe infection
    • Travelers
    • Treatment outcome
    • Intravenous
    • Artesunate
    • Hospitalization
    • Evaluation
    • Mortality
    • Clearance
    • Parasite detection
    • Adverse effects
    • Anemia
    • Effectiveness
    • Tolerability
    • Belgium
    • Netherlands
    • Europe-West

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