Descriptive Study on the Efficacy and Safety of Artesunate Suppository in Combination With Other Antimalarials in the Treatment of Severe Malaria in Sudan

Abstract

Abstract. Documentation on the efficacy of artesunate in Africa is limited, and no experience of artesunate use in Sudan is documented. Severe malaria in rural areas of Sudan, where facilities for the safe and effective use of parenteral quinine are lacking, is a frequent problem. Early treatment with artesunate suppositories would provide a simple method for use by unskilled staff and would be an alternative approach to treat malaria in settings with poor resources. We describe a hospital-based study of rectal artesunate in 100 adult patients with severe falciparum malaria with a dose derived from pharmacokinetic data (200 mg every 8 hours) over 3 days, which halted progression of severe disease and had a low fatality rate. The dosage schedule led to a rapid clinical response and reduced parasite clearance and fever subsidence times of (31.5 ± 10

Artesunate Suppositories versus Intramuscular Artemether for Treatment of Severe Malaria in Children in Papua New Guinea

“…artemether, could be suboptimal because of poor absorption (12,25,27,32). Evidence that artesunate suppositories are effective for severe malaria in adults (3,21,22) provided further justification for a trial of rectal artesunate with PNG children with complicated P. falciparum infections. The present study demonstrates the benefits of rectally administered artesunate for the initial treatment of severe malaria in children, with a more rapid fall in parasite density than that observed after i.m.…”

“…Artesunate suppositories have been identified by the World Health Organization (WHO) as having great promise, especially for treatment of childhood malaria (34). They have proved safe and efficacious for adults (3,20,22) and in small-scale studies of children with nonsevere infections from Africa (11,19), Southeast Asia (31), South America (10), and Papua New Guinea (PNG) (17). Their pharmacokinetic properties have been characterized previously (5,11,16,19), and maximal plasma drug concentrations, achieved within 1 to 2 h of administration of 10 to 20 mg/kg of body weight, are comparable to those when artesunate at 2 to 4 mg/kg is given by the oral, i.m., or i.v route (16,19).…”

Effectiveness of Antimalarial Drugs

“…Clinical trials indicated that rectal artesunate (combined with another blood-stage schizonticide) cleared parasitemia more quickly than parenteral quinine and with equal efficacy. 118,119 A global public health threat due to the resurgence of malaria stems from a general collapse of vectorcontrol operations and from resistance to chloroquine or sulfadoxine-pyrimethamine. Recent surveys show rates of treatment failure higher than 50 percent for chloroquine in most affected regions, as well as poor efficacy of sulfadoxine-pyrimethamine in sub-Saharan Africa and Southeast Asia.…”

Disposition of Artesunate and Dihydroartemisinin after Administration of Artesunate Suppositories in Children from Papua New Guinea with Uncomplicated Malaria

“…ARTS suppositories have been identified as having great promise, especially for the treatment of pediatric malaria (40). They can be administered when a child cannot take oral therapy and/or when parenteral drug administration is not possible and have proved effective in adults (4,28,29) and children (13,23,25,33) with uncomplicated malaria.…”