Artesunate for injection is now approved as initial drug treatment for severe malaria in both adults and children; it was previously available only under an investigational new drug protocol. Artesunate should be followed by a full course of treatment with an oral antimalarial drug to prevent relapse.

Malaria isn't common in the United States and most cases are attributed to world travel to places where the disease is endemic. Malaria relies on two hosts, mosquitos and humans. When an infected mosquito bites a human, it injects a parasite, known as a sporozoite, into the host. Sporozoites infect liver cells and red blood cells (RBCs), eventually destroying RBCs as they mature and multiply. When the RBCs rupture, daughter parasites called merozoites are released and continue to infect RBCs and destroy them. Infection of RBCs produces the signs and symptoms of malaria. The disease is spread back to mosquitos when they bite an infected human, creating a chain of infection. A dormant form of certain parasites, known as hypnozoites, can remain inactive in the liver for weeks or years if untreated, causing relapses of malaria. Artesunate doesn't treat the hypnozoite stage of the parasite, so it will not prevent relapses.

Malaria is classified as uncomplicated or severe. In uncomplicated cases, the patient typically has fever, chills, sweats, headaches, nausea and vomiting, body aches, and general malaise. Severe malaria can result in organ failure or damage, severe anemia, coagulation disorders, metabolic acidosis, and hypoglycemia.

The most common adverse effects of artesunate are acute renal failure requiring dialysis, hemoglobinuria, and jaundice. Severe hypersensitivity reactions and posttreatment hemolysis are also possible.

Nurses should read the artesunate product label for directions regarding dilution and rate of administration. Patients should be monitored closely for anaphylaxis and other hypersensitivity reactions during infusion. Patient education should include the importance of taking the full dose of the oral antimalarial drug prescribed to prevent relapses of malaria.

For complete prescribing information for artesunate for injection, see http://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213036s000lbl.pdf.