Abstract

SAFETY AND EFFICACY OF ARTEMISININ AND ITS DERIVATIVES IN THE TREATMENT OF SEVERE P. FALCIPARUM MALARIA INFECTION: A REVIEW

Mensur Shafie* and Mebrahtu Eyasu

ABSTRACT

Malaria is a protozoal disease caused by the protozoa plasmodium. P.falciparum and P. vivax cause the significant majority of malaria infections. P. falciparum, which causes most of the severe cases and deaths, is generally found in tropical regions, such as sub-Saharan Africa and Southeast Asia, as well as in the Western Pacific and in countries sharing the Amazon rainforest. In 2000, malaria caused 350 to 500 million clinical episodes annually and resulted in over one million deaths, most of which affect children under 5 years old in sub- Saharan Africa. Severe malaria is most commonly caused by infection with Plasmodium falciparum, although P. vivax and P. knowlesi can also cause severe disease. The risk is increased if treatment of an uncomplicated attack of malaria caused by these parasites is delayed. Severe malaria is a medical emergency and may rapidly progress to death without prompt and appropriate treatment. Malaria infections may cause vital organ dysfunction and death. Severe malaria is defined by clinical or laboratory evidence of vital organ dysfunction. Nearly all deaths from severe malaria result from infections with P. falciparum. The mortality of untreated severe malaria (particularly cerebral malaria) is thought to approach 100%. With prompt, effective antimalarial treatment and supportive care the mortality falls to 15–20% overall. Until recently, the standard treatment of severe malaria was intravenous quinine. Frequent adverse effects, however, and reports of limited clinical efficacy in some falciparum malaraia–endemic areas preclude its usefulness. Currently different studies have recognized the effectiveness of artemisinin and its derivatives for treatment of severe malaria and recommended them as 1st line options for the treatment of the disease. Based on these recommendations and the findings of different studies this review also concludes artemisinins specially IV artesunate is more safe and efficacious for treatment of severe p. falciparum malaria both in adults and children and recommends the ministry of health and regional health offices to facilitate availability and utilization of these drugs for the disease.

Keywords: Artemisinin; Plasmodium falciparum; malaria infection; artesunate; and Plasmodium.