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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