title: Life-saving rectal artesunate for complicated malaria in children.
abstract: We report the effectiveness of two regimens of rectal artesunate formulation in treating 13 Thai children with cerebral/complicated falciparum malaria. The drug was given at an initial dose of 40 mg/kg bodyweight, in 3 or 4 divided doses in the first 24 hours, followed by 10 mg/kg bodyweight once daily for three consecutive days. Mefloquine, at a dose of 15 mg/kg bodyweight was given orally at 72 hours after the initial dose of artesunate, followed by 10 mg/kg bodyweight 6 hours later. Three cases with cerebral malaria gained consciousness within 20 hours of artesunate administration. The median time required for reduction of parasitemia by 90% of the initial value (P90) in 13 children was 11.2 hours. No recrudescence was observed in any of the patients during the 28-day follow-up period. Plasma concentrations of artesunate and dihydroartemisinin (active plasma metabolite of artesunate) measured in two patients who received the high initial dose regimen (20 mg/ kg bodyweight) suggested rapid absorption and adequate plasma concentrations of both compounds following the administration of artesunate via the rectal route. Further studies for the optimized regimen of rectal artesunate in the treatment of cerebral/complicated childhood falciparum malaria in areas of multidrug resistance are warranted.
authors.affiliation: Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Rd, Bangkok 10400, Thailand. tmkps@mahidol.ac.th
authors.forename: Krisana
authors.initials: K
authors.lastname: Pengsaa
authors.forename: Chukiat
authors.initials: C
authors.lastname: Sirivichayakul
authors.forename: Kesara
authors.initials: K
authors.lastname: Na-Bangchang
authors.forename: Itthipon
authors.initials: I
authors.lastname: Thaiarporn
authors.forename: Anong
authors.initials: A
authors.lastname: Chaivisuth
authors.forename: Amnaj
authors.initials: A
authors.lastname: Wongsuwan
authors.forename: Phanorsri
authors.initials: P
authors.lastname: Attanath
authors.forename: Chanathep
authors.initials: C
authors.lastname: Pojjaroen-Anant
authors.forename: Pataraporn
authors.initials: P
authors.lastname: Wisetsing
authors.forename: Pornthep
authors.initials: P
authors.lastname: Chanthavanich
authors.forename: Arunee
authors.initials: A
authors.lastname: Sabchareon
mesh_terms: D000285:Administration, Rectal; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D037621:Artemisinins / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000077332:Artesunate; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D006801:Humans; D016779:Malaria, Cerebral / Q000188:drug therapy* / Q000469:parasitology; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology; D015767:Mefloquine / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D010963:Plasmodium falciparum / Q000187:drug effects*; D012717:Sesquiterpenes / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D013488:Suppositories; D013785:Thailand; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D013488:Suppositories; D000077332:Artesunate; D015767:Mefloquine