title: Treatment outcome of intravenous artesunate in patients with severe malaria in the Netherlands and Belgium.
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.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, the Netherlands. a.r.vegter@amc.uva.nl
authors.forename: Annemarie R
authors.initials: AR
authors.lastname: Kreeftmeijer-Vegter
authors.forename: Perry J
authors.initials: PJ
authors.lastname: van Genderen
authors.forename: Leo G
authors.initials: LG
authors.lastname: Visser
authors.forename: Wouter F W
authors.initials: WF
authors.lastname: Bierman
authors.forename: Jan
authors.initials: J
authors.lastname: Clerinx
authors.forename: Cees K W
authors.initials: CK
authors.lastname: van Veldhuizen
authors.forename: Peter J
authors.initials: PJ
authors.lastname: de Vries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects; D037621:Artemisinins / Q000008:administration & dosage* / Q000009:adverse effects; D000077332:Artesunate; D001530:Belgium; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008288:Malaria / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D014195:Travel; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate