An overview of the use of artemisinins in the treatment of malaria in the UK.

The authors briefly describe malaria as a disease, and the artemisinins as a drug group: these are based on compounds found in the leaves of the sweet wormwood plant and were discovered as a result of investigating the properties of plants used in traditional Chinese medicine.

Artemisinins are highly effective, rapidly-acting, antimalarials but are short-acting, therefore combinations with longer-acting drugs have been investigated successfully: these include combinations with mefloquine, and with lumefantrine (licensed in the UK as Riamet).

Riamet is available for oral use only, and while there are injectable artemisinins available, they are only manufactured in China and Vietnam and do not comply with international Good Manufacturing Practice standards. Despite this, they are successfully used in south-east Asia and the water-soluble artesunate is imported into the UK as non-licensed special for use in specialist centres. The review describes the use of artemisinins in both uncomplicated and complicated malaria, and the use of injectable artesunate in the UK.

Added 4/5/2011: An article in the May 2011 edition of the DTB relates to and updates this document.  Intravenous artesunate has been assessed as part of the World Health Organization Prequalification Programme (WHO PQP) and the relevant manufacturing site was found to comply with GMP at the time of inspection.  In addition, a further trial of artesunate versus quinine (both given parenterally) in the treatment of African children with severe falciparum malaria (AQUAMAT) has now been published.  This found that artesunate substantially reduced the primary endpoint of in-hospital mortality (8.5% vs. 10.9%, odds ratio for death 0.75, 95% CI 0.63 to 0.90), and the authors concluded that parenteral artesunate should replace quinine as the treatment of choice for severe falciparum malaria worldwide.

Based on these new developments, the authors of DTB article “believe that artesunate should be endorsed as first-line treatment of severe malaria in both adults and children”.