What's the recommended dosage reduction for artesunate in allergic cases?

Short answer: there is no recommended dose reduction for artesunate in allergic cases.

If a patient has a suspected or confirmed allergy to artesunate (or to artemisinins in general), artesunate should be avoided and an alternative antimalarial regimen should be used per local guidelines (e.g., IV quinidine/quinine-based therapy with doxycycline or clindamycin, or an appropriate ACT regimen if not contraindicated).

Key points:
- No dose reduction is advised to tolerate an allergy; the drug should be avoided.
- If an allergic reaction occurs, manage per allergic reaction protocols and switch to an alternative antimalarial.
- For severe malaria, follow local guidelines for alternatives to artesunate (e.g., quinidine/quinine-based regimens) and consult infectious disease or malaria specialists as needed.