Alternative Chemotherapy for Severe Malaria

Artemesinin and derived compounds should be considered for the treatment of P. falciparum malaria that fails standard drug regimens and for severe falciparum malaria acquired in areas where P. falciparum is known to be multidrug-resistant:

• Artesunate 2.4 mg/kg by intravenous or intramuscularly injection, followed by 1.2 mg/kg at 12 and 24 hours, then 1.2 mg/kg daily. Parenteral artesunate is unstable in water and must be reconstituted in 5% sodium bicarbonate solution prior to administration (Meshnick et al., 1996; White, 1996b).

• Artemether 3.2mg/kg by intramuscular injection, followed by 1.6 mg/kg daily, can be used.

• Artesunate suppositories have been shown to clear P. falciparum parasitaemia as rapidly as i.v. artesunate and more rapidly than i.v. quinine (Hien et al., 1992).

Mefloquine and halofantrine have been used as alternatives to quinine/quinidine and artesunate/

artemether therapy, but halofantrine has potential serious cardiotoxicity, referred to previously. Recent studies suggest that the combination of artemesinin derivatives and mefloquine may be more effective than either drug alone and may prevent the late recrudescences typically observed with artesunate alone (Looareesuwan et al, 1992). Artemesinin derivatives appear to have the added advantage of treating sexual forms.

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