Artesunate for injection (Amivas LLC), a semi-synthetic artemisinin derivative, is now approved by the FDA for initial (induction) treatment of severe malaria in children and adults. It has been available from the CDC on a compassionate use basis since 2007. Artemether/lumefantrine (Coartem), another artemisinin-based drug, was approved earlier for oral treatment of uncomplicated Plasmodium falciparum malaria. IV artesunate is now the only FDA-approved injectable antimalarial drug available in the US; IV quinidine has been discontinued.

The FDA has approved artemether-lumefantrine (Coartem - Novartis) for oral treatment of uncomplicated Plasmodium falciparum malaria. It is not approved for prophylaxis. Artemether-lumefantrine is the first artemisinin-based drug approved for use in the US. Artemisinins are Chinese herbal products used worldwide to treat malaria. The intravenous formulation of artesunate, another artemisinin, is available in the US through the CDC.

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.

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Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites. The table below lists first-choice and alternative drugs for most parasitic infections. The brand names and manufacturers of the drugs are listed in this article.

Superseded--purchase updated Parasitic Infections article
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites.

Note: Drugs for Parasitic Infections, revised and updated, is now available to both subscribers and nonsubscribers on our web site. This article, a bi-annual feature of The Medical Letter for many years, will not be published as a printed issue in 2002, but is included in the 16th edition of The Medical Letter Handbook of Antimicrobial Therapy. The handbook is now available and can be ordered by calling customer service at 1-800-211-2769.

(Superseded by the 2013 version. Click here to purchase.)
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites. The table lists first-choice and alternative drugs for most parasitic infections.