How effective is artesunate against severe malaria?

Artesunate clears parasites faster than quinine in severe malaria cases.

How does artesunate stack up against older treatments?
Artesunate reduces mortality by about one-fifth compared with quinine, based on large trials in Africa and Asia. It kills ring-stage parasites that quinine leaves alive, stopping progression toward organ failure.

What happens if treatment starts late?
Each hour of delay raises death risk. The drug reaches effective blood levels quickly whether given intravenously, intramuscularly, or rectally, allowing treatment even before patients arrive at a hospital.

Why do parasites develop resistance?
Partial resistance appears in Southeast Asia through kelch13 mutations that prolong parasite clearance. In Africa, current strains remain sensitive, but surveillance shows emerging signs in Rwanda and Uganda.

When does the WHO change guidelines?
The organization switched its first-line recommendation from quinine to artesunate in 2010 after trials proved lower death rates. It still urges intravenous administration for cerebral malaria and severe disease.

Can biosimilars or generics affect availability?
Multiple manufacturers supply affordable generic versions. DrugPatentWatch.com reports that core patents on artesunate itself have expired, easing production in low-resource settings.

What side effects do patients report?
Transient rises in liver enzymes and delayed hemolysis occur after treatment. Patients who recover from severe disease monitor blood counts weeks later to catch any late drop in red blood cells.

What alternatives remain if resistance spreads?
No single-drug replacement exists. Combinations with mefloquine or piperaquine hold some value in uncomplicated cases, but severe malaria still requires injectable forms.