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2.2.2.1

Definitive Treatment — Parenteral Artesunate

Guidelines for the Treatment of Malaria in Malawi, 6th Edition, 2025. Chapter 1, Severe Malaria.

Treatment

Intravenous (IV) artesunate is the treatment of choice for the management of severe malaria. Artesunate may also be administered intramuscularly if intravenous bolus is not feasible.

For children < 20 kgs, give artesunate 3 mg/kg body weight while children > 20 kgs and adults, give artesunate 2.4 mg/kg body weight IV or IM on admission (at 0 hour), repeat at 12 hours and 24 hours, after initiating the first dose then once daily for not more than six days. However, once the patient can take oral treatment and at least 24 hours of parenteral artesunate has been administered, discontinue parenteral therapy, and commence full course of LA or DP.

There should be an interval of at least 8 hours between the last dose of artesunate and the first dose of LA or DP.

Artesunate is dispensed as a powder of artesunic acid. This must be dissolved in 5% sodium bicarbonate to form sodium artesunate. The solution is then diluted in approximately 5% dextrose.

Artesunate or quinine should never be injected into the buttocks. The solution should be freshly prepared prior to administration and should never be stored.

Table 2.6 — Number of required vials for parenteral artesunate by body weight (IV preparation)
Table 2.6 — Number of required vials for parenteral artesunate by body weight (IV preparation). Open the image to zoom.
Table 2.8 — Use of 30, 60, 120 mg vials of injectable artesunate to minimize wastage (IM and IV routes)
Table 2.8 — Use of 30, 60, 120 mg vials of injectable artesunate to minimize wastage (IM and IV routes). Open the image to zoom.

Check doses against the printed guideline and your clinical judgement before treating a patient. Spotted an error? Report it from the contact links below.

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