Practical Aspects of Artesunate Administration in Severe Malaria Treatment

Abstract

In management of severe malaria, aresunate is preferred antimalarial drug. It is better than quinine in reduction of mortality. Parenteral artesunate may be given either intravenous (IV) or intramuscular (IM) routes. However IV route is preferred route of administration since during severe falciparum malaria infection, capillary sequestration may delay drug absorption from muscle via IM administration to blood circulation. Artesunate can be activated by dissolving the powder of artesunic acid with sodium bicarbonate [1]. During mixing artesunic powder with sodium bicarbonate, the solution should be shaked strongly until dissolved, then the solution will be cloudy. The reconstituted solution will clear in about 1 min. If it is not clear, it should be discarded. Artesunate is poorly soluble in water and has poor stability in aqueous solutions at neutral or acid pH. Artesunic acid is sufficiently soluble in sodium bicarbonate injection (50 mg/ml) to prepare a clear solution [2]. The pH of the final solution is not greater than 8. After dissolving with sodium bicarbonate, artesunate solution in vial should be freshly used for each administration. Unused solution should be discarded and should not be stored in refrigerator for the next dose administration.