Intended for healthcare professionals

Rapid response to:

Practice BMJ Learning

Malaria: an update on treatment of adults in non-endemic countries

BMJ 2006; 333 doi: (Published 27 July 2006) Cite this as: BMJ 2006;333:241

Rapid Response:

Artesunate for severe malaria

We welcome the update on malaria treatment by Whitty et. Al. (1) and
agree on most points. However, the European Network on Imported
Infectious Disease Surveillance (TROPNETEUROP) considers that after the
cited SEQUAMAT study (2) there is enough evidence to propose i.v.
artesunate as the first choice treatment of severe imported malaria in
adults, regardless the continent visited. The study included not only
patients from South East Asia, but also from the Indian sub-continent,
where quinine resistance is not an issue. Therefore, the significant
difference in mortality does not appears to be attributable to quinine
resistance, but rather to the different mode of action of the two drugs.
Unfortunately, the current available artesunate preparations do not comply
with standard Good Manufacturing Practice (GMP) requirements and this
hampers the drug availability both in endemic and non endemic countries,
resulting in excess deaths. TROPNETEUROP has addressed this problem with
an ad hoc statement (3). Briefly, TROPNETEUROP recommends the use of
intravenous artesunate in all adult patients with severe malaria and
advocates that this first choice drug should be made readily available in
hospitals of endemic as well as non endemic countries.

1. Whitty C, Lalloo D, Ustianowski A. Malaria: an update on
treatment of adults in non-endemic
countries. BMJ 2006;333:241-5.

2. Dondorp A, Nosten F, Stepniewska K, Day N, White N. South East
Asian Quinine Artesunate Malaria Trial (SEAQUAMAT) group. Artesunate
versus quinine for treatment of severe falciparum malaria: a randomized
trial. Lancet 2005;366:717-25.

3. Jelinek T. Intravenous artesunate recommended for patients with
severe malaria: position statement from TropNetEurop. Euro Surveill
2005;10(11):E051124.5. Available from:

Competing interests:
The Authors are the members of the Steering Committee of TROPNETEUROP

Competing interests: No competing interests

28 July 2006
Zeno Bisoffi
Centre for Tropical Diseases
Ron Behrens, Anders Björkman, Joaquim Gascon and Tomas Jelinek for TROPNETEUROP
S. Cuore Hospital, 37024 Negrar (Verona), Italy