Rectal artesunate beneficial in young children with severe malaria, but may be harmful in older children, adults

May 30, 2014

Researchers from the Cochrane Infectious Diseases Group, hosted at LSTM, conducted an independent review of the effects of pre-referral rectal artesunate for people with severe malaria, published in the Cochrane Library today.

The review follows a large trial of rectal artesunate in 2009 which led the World Health Organization to recommend its use.

Severe malaria is a serious medical condition caused by infection with the Plasmodium parasite. It is treated by giving injections of antimalarial drugs, which need to be started as quickly as possible to reduce the risk of death and brain damage. In some where malaria is common, injections are unavailable and people often die before reaching hospital. In these areas rectal artesunate could feasibly be administered by volunteers without formal healthcare training, to start treatment before transporting the patient.

The Cochrane review authors searched extensively for other trials, but only the single trial from 2009 directly assessed pre-referral treatment. This trial enrolled over 17,000 patients at various sites across Ghana, Tanzania and Bangladesh, and trained village volunteers to recognize the symptoms of , administer rectal artesunate, and refer all patients to hospital.

At the African sites, only children aged 6 to 72 months were enrolled and there were fewer deaths with rectal artesunate than with placebo. This expected finding was replicated in Asia, but complicated by the unexpected finding of more deaths with artesunate in older children (aged >72 months) and adults. The trial was well designed to minimize bias, but the number of deaths in the older age group was very low.

Consequently, there is the possibility that this finding occurred by chance but without further trials neither the trial authors, nor the review authors were able to reliably explain this finding.

Joseph Okebe, the lead author of the review said: "In rural areas without access to injectable antimalarials rectal artesunate probably reduces deaths in young children. However, the low quality evidence that it is harmful in and adults must be taken into account when formulating national policies on pre-referral treatment."

Explore further: Rectal artemisinins rapidly eliminate malarial parasites

More information: Okebe J, Eisenhut M. "Pre-referral rectal artesunate for severe malaria." Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD009964. DOI: 10.1002/14651858.CD009964.pub2.

Related Stories

Rectal artemisinins rapidly eliminate malarial parasites

March 28, 2008

Artemisinin-based suppositories can help ‘buy time’ for malaria patients who face a delay in accessing effective, injectable antimalarials, according to research published in the online open access journal BMC Infectious ...

Major malaria study leads WHO to revise treatment guidelines

April 27, 2011

The results of the largest ever clinical trial among patients hospitalised with severe malaria - the Wellcome Trust-funded AQUAMAT study - have led the World Health Organisation (WHO) to revise its guidelines for the treatment ...

Malaria drug association with hemolytic anemia unclear

January 11, 2013

(HealthDay)—Artesunate, a drug used in the treatment of severe malaria, may or may not be associated with hemolytic anemia, so the U.S. Centers for Disease Control and Prevention recommends close monitoring of patients ...

Recommended for you

Zika virus may persist in the vagina days after infection

August 25, 2016

The Zika virus reproduces in the vaginal tissue of pregnant mice several days after infection, according to a study by Yale researchers. From the genitals, the virus spreads and infects the fetal brain, impairing fetal development. ...

In sub-Saharan Africa, cancer can be an infectious disease

August 26, 2016

In 1963, Irish surgeon Denis Parson Burkitt airmailed samples of an unusual jaw tumor found in Ugandan children to his colleague, Anthony Epstein, at Middlesex Hospital in London. Epstein, an expert in chicken viruses and ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.