WHO Review Recommends Artemisinin Suppositories for Emergency Malaria Treatment

A recent study concluded that suppositories containing a member of the artemisinin family of drugs were effective for early treatment for severe malaria in remote settings where injectable anti-malarial therapy may not be feasible.

Artemisinin (a sesquiterpene lactone) is isolated from the shrub Artemisia annua long used in traditional Chinese medicine for the treatment of malaria. Not all shrubs of this species contain artemisinin, which apparently it is only produced when the plant is subjected to certain conditions. It can be synthesized from artemisinic acid. Artesunate is a semi-synthetic derivative of artemisinin that is water-soluble and may be given by injection.

In the study sponsored by the World Health Organization (Geneva, Switzerland) individual patient data from 1167 patients in 15 clinical trials of rectal artemisinin derivative therapy (artesunate, artemisinin, and artemether) were pooled in order to compare the rapidity of clearance of Plasmodium falciparum parasites from the blood and the incidence of reported adverse events with each treatment. A parasite reduction of >90% at 24 hours was defined as parasitological success.

Results reported in the March 28, 2008, online edition of the open access journal BMC Infectious Diseases revealed that artemisinin and artesunate suppositories rapidly eliminated parasites and appeared to be safe. There was less data on artemether and dihydroartemisinin suppositories. A single higher dose of rectal artesunate treatment was five times more likely to achieve >90% parasite reductions at 24 hours than were multiple lower doses of rectal artesunate, or a single lower dose administration of rectal artemether. The more rapid parasite clearance of single high-dose regimens suggested that achieving immediate high drug concentrations might be the optimal strategy.

The authors concluded, "Early effective treatment with artemisinin-based suppositories has potential as a lifesaving intervention, particularly at the periphery of the health-care system, where suppositories might be administered early in lieu of parenteral treatment in remote communities by relatively untrained personnel. Combined with accurate diagnosis and artemisinin-based combination therapy, rectal artemisinins have been effectively used to reduce malaria incidence and mortality in Asia, an approach which holds great promise for malaria control elsewhere.”


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