Intravenous Artesunate for Transfusion-Transmitted Plasmodium vivax Malaria in a Preterm Neonate

Abstract

Transfusion-transmitted malaria (TTM) in neonates is rare. TTM can occur in both endemic and nonendemic areas because the current tests used to screen the donor blood for malaria are unreliable when there is low parasitemia. Malaria must be considered as an important differential diagnosis for neonatal sepsis after exchange transfusion. Management strategy in TTM in the neonatal period is not standardized; exchange transfusion is often considered. We used intravenous artesunate in a case of severe malaria caused by Plasmodium vivax in a 30-week preterm neonate after packed red blood cell transfusion on day 19 of life. This is the first clinical report of parenteral artesunate successfully used in the neonatal period. We emphasize the need for further investigation of the safety and efficacy of intravenous artesunate in the treatment of severe neonatal malaria.

Intestinal Permeability of Artesunate-Loaded Solid Lipid Nanoparticles Using the Everted Gut Method

“…Its solubility increases with pH which could explain the increase in the rate of drug release from pH 1.2 to pH 6.8 observed in this study [9]. Moreover, artesunate contains a free carboxylic acid group which makes it susceptible to acid hydrolysis [48]; hence it is highly unstable under aqueous acidic conditions [12, 13]. However, the rate of drug release from the SLN was fivefold greater than that of the pure drug at pH 1.2.…”

“…Polymeric nanoparticles are prepared using high concentrations of organic solvents. However, artesunate is highly unstable in aqueous conditions [12] and hence may be degraded by these solvents, leading to drug losses during preparation. Solid lipid nanoparticles avoid the use of organic solvents improving the physical stability of artesunate leading to fewer drug losses [23].…”

“…It also has a relatively low oral bioavailability of approximately 40% [10, 11]. It is highly unstable in aqueous acidic and neutral conditions [12, 13]. Its active metabolite (DHA) is rapidly decomposed to the inert end product, deoxyartemisinin, and is also easily reduced by biological molecules at physiological pH 7.4 [14].…”

Artesunate Dry Emulsion Formulation Combined with Antibiotics for Treatment of Helicobacter pylori Infections: In Vitro/In Vivo Evaluation

“…After oral administration, artesunate generally remains insoluble in gastric acid and is rapidly hydrolyzed into dihydroartemisinin (DHA). It is worth mentioning that DHA is less stable and readily decomposes into the inactive product 2-deoxyartemisinin [18][19][20]. In this context, it is important to develop a stable and soluble form of artesunate that can effectively exert its antibacterial activity in the acidic environment of the stomach.…”

“…After oral administration, artesunate generally remains insoluble in gastric acid and is rapidly hydrolyzed into dihydroartemisinin (DHA). It is worth mentioning that DHA is less stable and readily decomposes into the inactive product 2-deoxyartemisinin [ 18 , 19 , 20 ].…”