Butungeshwar Pradhan1
BACKGROUND
Acute severe falciparum malaria is a pernicious and vicious circle of pathophysiologic state and is a medical emergency. The priority of treatment is the parenteral administration of safe and adequate doses of appropriate effective antimalarials given as soon as possible in the setting of the highest possible levels of clinical care. Decreasing mortality is more important than cure of malaria, thus survival of the patients is the key factor. Antimalarial drugs have stage specific actions on plasmodium falciparum. Artemisinin are most rapidly acting of known antimalarials and they have broadest time window of activity. Recent study showed decreased mortality of 34.7% was by intravenous artesunate instead of quinine. Currently, the therapeutic doses of intravenous artesunate to treat severe malaria are in the range of 2-2.4 mg/kg produces peak drug concentrations (Cmax) with great inter-individual variability with lower Cmax than needed for hyperparasitaemia to efficaciously cover each RBCs as infected cells can concentrate 100-300 fold more dihydroartemisinin (DHA) than the normal RBCs during the first 1-2 hrs. after dosing indicating that intravenous dose should be increased to a higher levels than current loading dose to treat severe malaria with hyperparasitaemia to decrease further morbidity and mortality.
