Intravenous Artesunate in Artemisinin-Resistant Severe Malaria in Uganda

In 2012, after the publication of the findings of the AQUAMAT trial,1 practitioners in Africa began to administer parenteral (both intravenous and intramuscular) artesunate to replace quinine therapy as first-line treatment for severe Plasmodium falciparum malaria. The trial had shown that artesunate reduced mortality by 22.5%, and its use saved the lives of more than 100,000 children annually.2 However, the emergence and spread of artemisinin partial resistance (ART-R) in Africa represents a public health threat. Such resistance results in delayed parasite clearance after artemisinin treatment, mediated by mutations in the gene encoding P. falciparum kelch protein 13 (PfK13). Most deaths from malaria in children occur soon after hospital admission,1 so rapid control of infection is vital.