The World Health Organisation (WHO) recommends artemisinin or one of its derivatives — often used in combination with longer-lasting partner drugs — as first-line treatment for all malaria cases. For uncomplicated malaria, WHO recommends three days of oral therapy with any of the following five artemisinin combination therapies (ACTS) : artemether/fluofluorel, artesunate/amodiaquine (ASAQ), artesunate/mefloquine, dihydroartemisinin/piperaquine, or artesunate/sulfadoxine/pyrimethamine. In each of these combinations, the artemisinin derivative kills the parasite quickly, but itself is quickly cleared from the body. Longer-lived companion drugs kill the remaining parasites and provide some lingering protection against reinfection.
For severe malaria, WHO recommends intravenous or intramuscular treatment with artesunate, the artemisinin derivative, for at least 24 hours. Artesunate treatment continues until the person being treated is well enough to take the oral drug. They then take a three-day ACT course to treat simple malaria. In the absence of artesunate, WHO recommends intramuscular injection of artemether, a less potent artemisinin derivative. For children under 6 years of age who cannot receive artesunate, WHO recommends rectal administration of artesunate and referral to a resourced facility for further care.
Artemisinin is not used for malaria prevention because the drug has an extremely short activity (half-life). To be effective, it must be given several times a day.
contraindications
Because of the lack of studies on the safety of artemisinin in early pregnancy, WHO recommends that women avoid ACT during the first trimester of pregnancy. Instead, the World Health Organization recommends a seven-day course of clindamycin and quinine. For pregnant women in their second or third trimester, WHO recommends ACT as normal treatment. In other groups, certain ACTS are avoided because of side effects of companion drugs: sulfadoxine-pyrimethamine is avoided in the first few weeks of life as it interferes with the effects of bilirubin and may worsen neonatal jaundice. A combination of trimethoprime/sulfamethoxazole, antiretroviral therapy with zidovudine, and ASAQ has been associated with neutropenia in HIV-positive individuals. A combination of the HIV drugs efavirenz and ASAQ is associated with hepatotoxicity.
