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Belard, Sabine; Brand, Judith; Schulze-Sturm, Ulf; Janda, Ales; Both, Ulrich von; Tacoli, Costanza; Alberer, Martin; Kempf, Caroline; Stegemann, Miriam S.; Krüger, Renate; Varnholt, Verena; Blohm, Martin; Reiter, Karl; Zoller, Thomas; Suttorp, Norbert; Mall, Marcus; Bernuth, Horst von; Gratopp, Alexander; Hübner, Johannes; Hufnagel, Markus; Kobbe, Robin and Kurth, Florian (2019): Intravenous Artesunate for Imported Severe Malaria in Children Treated in Four Tertiary Care Centers in Germany A Retrospective Study. In: Pediatric Infectious Disease Journal, Vol. 38, No. 11, E295-E300

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Background: Intravenous artesunate (ivA) is the standard treatment for severe malaria. Data systematically evaluating the use of ivA in pediatric patients outside malaria-endemic regions are limited. The aim of this case series was to summarize efficacy and safety of ivA for imported severe malaria in children in Germany. Methods: Our retrospective case series included pediatric patients with imported severe malaria treated with at least 1 dose of ivA (Artesun, Guilin Pharmaceutical;Shanghai, China) at 4 German tertiary care centers. Severe malaria was defined according to World Health Organization criteria. Results: Between 2010 and 2018, 14 children with a median [interquartile range (IQR)] age of 6 (1;9.5) years were included. All children were of African descent. All but 2 patients had Plasmodium falciparum malaria;1 child had P. vivax malaria and 1 child had P. falciparum and P. vivax co-infection. Median (IQR) parasitemia at admission in patients with P. falciparum was 9.5% (3;16.5). Patients were treated with 1-10 [median (IQR) 3 (3;4)] doses ivA. All but one patient received a full course of oral antimalarial treatment. Parasite clearance was achieved within 2-4 days, with the exception of 1 patient with prolonged clearance of peripheral parasitemia. Three patients experienced posttreatment hemolysis but none needed blood transfusion. Otherwise ivA was safe and well tolerated. Conclusions: ivA was highly efficacious in this pediatric cohort. We observed episodes of mild to moderate posttreatment hemolysis in approximately one-third of patients. The legal status and usage of potentially lifesaving ivA should be evaluated in Europe.

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