A potentially life-saving, single, rectally-administered dose of artesunate can halt the progression of more severe malaria, according to findings in a paper published in The Lancet (Vol 363, May 15, 2004), co-authored by UCT clinical pharmacology's Dr Karen Barnes, Professor Peter Folb and Dr Helen McIlleron, as well as statistical sciences' Dr Francesca Little, working together with colleagues in Malawi.

Plasmodium falciparum malaria causes hundreds of thousands of deaths annually, especially among children in sub-Saharan Africa. One of the main reasons for the high mortality is the delay in receiving effective medicine, says the report.

Many patients with malaria can't take orally administered medicines, and live many hours or days away from facilities that can provide injectable treatment. As delays in accessing injectable treatment can prove fatal, the nine-member team of authors investigated the reliability and efficacy of a single dose of artesunate in the initial management of moderately severe falciparum malaria, providing antimalarial cover while patients are transferred to hospitals for completion of cure. This is potentially life-saving as progression from being unable to take oral treatment to severe malaria can happen within hours, and 10-40% of those treated for severe malaria die from this disease.

The study involved 109 children and 35 adults. All the artesunate-treated patients showed adequate drug absorption. A single rectal dose of artesunate is associated with rapid reduction in parasite density in adults and children with moderately severe malaria within the initial 24 hours of treatment.

The drug was selected as part of a WHO-lead investigation as a candidate for rectal administration, mainly as a result of its rapid antimalarial activity, favorable bioavailability and safety and efficacy profiles.