Intravenous Artesunate for Imported Severe Malaria in Children Treated in Four Tertiary Care Centers in Germany: A
Sabine Bélard1,2, Judith Brand1, Ulf Schulze-Sturm3
1From the Department of Paediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Insights
Intravenous artesunate (ivA) is effective for treating severe imported malaria in children in Germany. While generally safe, some patients experienced mild to moderate post-treatment hemolysis.
Area of Science:
- Pediatric Infectious Diseases
- Tropical Medicine
- Pharmacovigilance
Background:
- Intravenous artesunate (ivA) is the standard for severe malaria, but data in pediatric populations outside endemic areas are scarce.
- This case series evaluates ivA efficacy and safety for imported severe malaria in children treated in Germany.
Observation:
- 14 pediatric patients with imported severe malaria were treated with ivA between 2010-2018.
- Most patients had Plasmodium falciparum malaria; median parasitemia was 9.5%.
- Patients received a median of 3 doses of ivA, followed by oral treatment.
Findings:
- ivA demonstrated high efficacy, achieving parasite clearance within 2-4 days for most patients.
- Three patients (approx. one-third) experienced mild to moderate post-treatment hemolysis, none requiring transfusion.
- ivA was generally safe and well-tolerated in this pediatric cohort.
Implications:
- ivA is a highly effective treatment for severe imported malaria in children in a non-endemic setting.
- Post-treatment hemolysis is a potential side effect requiring monitoring.
- The regulatory status of ivA in Europe warrants re-evaluation to ensure access to this critical medication.
Background:
Intravenous artesunate (ivA) is the standard treatment for severe malaria. Data systematically evaluating the use of ivA in pediatric patients outside malaria-endemic regions are limited. The aim of this case series was to summarize efficacy and safety of ivA for imported severe malaria in children in Germany.
Methods:
Our retrospective case series included pediatric patients with imported severe malaria treated with at least 1 dose of ivA (Artesun, Guilin Pharmaceutical; Shanghai, China) at 4 German tertiary care centers. Severe malaria was defined according to World Health Organization criteria.
Results:
Between 2010 and 2018, 14 children with a median [interquartile range (IQR)] age of 6 (1;9.5) years were included. All children were of African descent. All but 2 patients had Plasmodium falciparum malaria; 1 child had P. vivax malaria and 1 child had P. falciparum and P. vivax co-infection. Median (IQR) parasitemia at admission in patients with P. falciparum was 9.5% (3;16.5). Patients were treated with 1-10 [median (IQR) 3 (3;4)] doses ivA. All but one patient received a full course of oral antimalarial treatment. Parasite clearance was achieved within 2-4 days, with the exception of 1 patient with prolonged clearance of peripheral parasitemia. Three patients experienced posttreatment hemolysis but none needed blood transfusion. Otherwise ivA was safe and well tolerated.
Conclusions:
ivA was highly efficacious in this pediatric cohort. We observed episodes of mild to moderate posttreatment hemolysis in approximately one-third of patients. The legal status and usage of potentially lifesaving ivA should be evaluated in Europe.
