Artikel
Efficacy and safety of artesunate for the treatment of severe malaria in Europe
I.v.-Artesunate zur Behandlung der komplizierten Malaria tropica in Europa
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Veröffentlicht: | 2. Juni 2010 |
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Gliederung
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Background: Large multicenter trials from South-East Asia have demonstrated an improved survival for i.v.-artesunate as compared to quinine for the treatment of severe malaria. For patients with severe malaria in Europe, quinine is still the mainstay of treatment and artesunate has not been evaluated systematically in this group of patients.
Methods: In this report, a case series of 22 patients returning from malaria-endemic regions with severe malaria treated in five different European centres is analysed retrospectively.
Results: All patients survived the infection and treatment with i.v.-artesunate was effective and induced a rapid clearance of parasitaemia. In four patients from three different treatment centres, a self-limiting, but prolonged episode of haemolysis after clearance of parasitaemia was observed. After exclusion of other causes, a review of treatment data suggests that this phenomenon might have been related to treatment with i.v.-artesunate. The recurring haemolysis peaked during the third week after the first dose of i.v.-artesunate and resolved spontaneously between the 3rd and 5th week. Three patients required transfusion of red cells.
Conclusion: i.v.-artesunate is a valuable and effective alternative to quinine for the treatment of severe malaria also for European patients and should not be withheld in patients where the benefit of improved survival may outweigh the risk of potential adverse reactions. The efficacy and safety profile of i.v.-artesunate should be prospectively evaluated, particularly with regard to signs of persistent or recurring haemolysis after parasitological cure.