A Simplified Intravenous Artesunate Regimen for Severe Malaria

Background. We compared a conventional empirically derived regimen with a simplified regimen for parenteral artesunate in severe malaria. Methods. This was a randomized, double-blind, placebo-controlled comparison to assess the noninferiority of a simplified 3-dose regimen (given at 0, 24, and 48 hours) compared with the conventional 5-dose regimen of intravenous artesunate (given at 0, 12, 24, 48, and 72 hours) in African children withPlasmodium falciparum malaria with a prespecified delta of 0.2. The total dose of artesunate in each group was 12 mg/kg. The primary end point was the proportion of children clearing $99% of their admission parasitemia at 24 hours. Safety data, secondary efficacy end points, and pharmacokinetics were also analyzed. Results. In 171 children (per protocol), 78% of the recipients (95% confidence interval [CI], 69%‐87%) in the 3-dose group achieved $99% parasite clearance 24 hours after the start of treatment, compared with 85% (95% CI, 77%‐93%) of those receiving the conventional regimen (treatment difference, 27.2%; 95% CI, 218.9% to 4.4%). Dihydroartemisinin was cleared slightly more slowly in those children receiving the higher 3-dose regimen (7.4 vs 8.8 L/h for a 13-kg child; P 5 .008). Conclusions. Pharmacodynamic analysis suggests that 3 doses of artesunate were not inferior to 5 doses for the treatment of severe malaria in children. Clinical Trials Registration. NCT00522132.