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. 2012 Mar 31:11:102.
doi: 10.1186/1475-2875-11-102.

Treatment outcome of intravenous artesunate in patients with severe malaria in the Netherlands and Belgium

Annemarie R Kreeftmeijer-Vegter  1 , Perry J van Genderen, Leo G Visser, Wouter F W Bierman, Jan Clerinx, Cees K W van Veldhuizen, Peter J de Vries
Affiliations

Treatment outcome of intravenous artesunate in patients with severe malaria in the Netherlands and Belgium

Annemarie R Kreeftmeijer-Vegter et al. Malar J. .

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 haemolytic anaemia 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 haemolytic anaemia 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.

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Figures

Figure 1
Figure 1
Haemoglobin values of patients with haemolysis after being treated for severe malaria with IV artesunate.
See this image and copyright information in PMC

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