People with malaria who are too ill to take oral medication can benefit from rectal artesunate as initial treatment

People with moderate to severe malaria who are too ill to take oral medication can benefit from a single dose of rectal artesunate as initial treatment, conclude authors of a study in this week's issue of THE LANCET.

Many people with severe malaria cannot take medicines orally, and delay in injectable treatment can be fatal. Malcolm Molyneux from the Universities of Malawi and Liverpool (UK) and colleagues assessed the effectiveness of artesunate given by rectal suppositories in managing the initial stages of moderate to severe falciparum malaria.

109 children and 35 adults were randomly assigned to rectal artesunate (single dose of about 10 mg/kg bodyweight) or quinine treatment (standard doses) given by intramuscular injections.

12 hours after treatment, more than 90% of children and adults given rectal artesunate achieved reductions of over one-third in parasite concentrations. Only 14% of children and 38% of adults given quinine achieved similar reductions.

Professor Molyneux comments: "Provided early administration of rectal artesunate does not deter patients from reaching a health-care facility that can provide further effective antimalarial treatment and appropriate supportive management, prereferral rectal artesunate has the potential to reduce malaria related morbidity and mortality. This treatment is of greatest relevance to communities in rural areas of malaria-endemic countries, which commonly bear the heaviest malaria burden and for whom parenteral treatment is often not immediately available".

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