The drug of choice for patients who require parenteral treatment for malaria is IV artesunate, which is available now from the CDC Malaria Branch (M-F, 8 AM-4:30 PM eastern time, 770-488-7788 or, after hours, 770-488-7100). Artesunate appears to be more effective than quinine1 and safer than quinidine, the other parenteral alternatives in the US. The CDC has supplies of artesunate in Atlanta and in 8 quarantine stations in major airports around the US. It will release the drug for appropriate patients (severe disease or unable to take oral drugs) if it can be supplied as quickly as quinidine, or if quinidine has failed, been poorly tolerated, or is contraindicated.

The herbal artemisinin derivatives artemether and artesunate are used worldwide for treatment of malaria caused by Plasmodium falciparum, but have not been marketed in the US.2,3 About 1500 cases of malaria are diagnosed each year in the US in returning travelers, and about 5% of these have severe disease.4

Artesunate is generally given over 3 days in 2.4 mg/kg doses at 0, 12, 24 and 48 hours. It should be accompanied as soon as possible by an oral drug such as atovaquone/proguanil (Malarone), doxycycline (Vibramycin, and others; not for children <8 years old), clindamycin (Cleocin, and others) or mefloquine (Lariam, and others).

1. A Dondorp et al. South East Asian Quinine Artesunate Malaria Trial (SEAQUAMAT) Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet 2005; 366:717.

2. Drugs for parasitic infections. New Rochelle, NY: The Medical Letter; 2007:34.

3. NJ White. Qinghaosu (artemisinin): the price of success. Science 2008; 320:330.

4. PJ Rosenthal. Artesunate for the treatment of severe falciparum malaria. N Engl J Med 2008; 358:1829.