Specialist advice recommended in difficult cases with very high parasite count, deterioration on optimal doses of quinine, infection acquired in quinine-resistant areas of south-east Asia) because IV artesunate may be available for named-patient use.
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
- Quinine IV is first line usually. 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.
Children ≤ 20 kg → 3 mg/kg
| Adults > 20 kg → 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
- Children ≤ 20 kg: use 3 mg/kg per dose.
- Adults > 20 kg: 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
