Severe Plasmodium falciparum Malaria Treated With Investigational Artesunate in the United States

Purpose: We describe here the case of a 40-year-old Nigerian male with severe Plasmodium falciparum malaria successfully treated with investigational intravenous (IV) artesunate. A 40-year-old Nigerian male was admitted to the medical intensive care unit for the treatment of severe malaria. The patient presented with the classic malaria paroxysm and altered mental status and was in acute renal failure. A blood parasite, thick and thin smear was performed revealing positive ring forms on smear which are characteristic of Plasmodium falciparum, with an estimated parasitemia of 2%. Per the Centers for Disease Control and Prevention (CDC) guidelines, the recommended treatment for severe malaria is with IV quinidine, the only Food and Drug Administration (FDA)-approved medication available for the treatment of severe malaria in the United States. However, quinidine was not immediately available, including from surrounding hospitals. As a result, the infectious diseases physician and pharmacist decided to contact the CDC to initiate the process for obtaining IV artesunate, an investigational drug only available via a FDA-approved Investigational New Drug (IND) protocol. Artesunate was flown into Houston later that night, and this drug was administered successfully to the patient. Patient responded to treatment and was discharged from the hospital on day 4. Conclusion: A patient with severe falciparum malaria was successfully treated with investigational artesunate procured from the CDC.