Global Health Journal Club Tropical Medicine

Hitting Malaria Below the Belt

Rectal Suppository
Rectal Suppository

Treatment of malaria, especially in remote areas, can be challenging.  Severe malaria infections can render a person incapacitated.  Vomiting, fever, lethargy and an inability to tolerate oral medications are some basic examples of barriers to getting the appropriate medicine in the person’s body.  Intravenous medications require a specially trained person to administer, providing the IV medicine is even available. 

The Lancet has an interesting article that looks at the efficacy of giving a pharmaceutical suppository, while the patient is being transported to a higher level of medical care.  The suppository used in their investigation contained Artesunate as their active ingredient.  The study looked specifically at reductions in mortality of patients who took extended time to reach a medical aid clinic, where advanced treatment was possible.  The artesunte suppositories had little effect on decreasing death in those who were able to reach the clinics within six hours.  However, those patients arriving to the clinics after 15 hours or more showed a reduction in mortality from 3.8% to 1.9% in those treated with rectal artesunate.

This information can help save lives of those who are living or traveling in remote areas, infected with malaria.  Typical treatment for travelers and adventurers in remote areas include “stand-by” treatment.  This is simply carrying an oral medication, such as mefloquine or atovaquone/proguanil, to be taken when the person begins to feel symptoms of malaria.  “Stand by” treatment should be used while the person begins to leave the remote area and seek medical attention.  It is not intended to be used and not followed up with a proper exam and diagnosis by a medical professional.  Several problems can occur with using a standard “stand-by” treatment:

  • Nausea and vomiting are common, possibly resulting in persons vomiting their dose of medicine back up
  • If the illness advances rapidly, the person may be unable to swallow oral medications
  • Some of the medicines used for stand-by treatment can be expensive

Rectal artesunate suppositories should be considered by all healthcare providers looking after people in remote malaria prone areas.  The purpose of this medicine should be similiar to a stand-by treatment and used while advanced medical care is being sought.  However, road conditions, methods of transport and distance to advanced medical care may require lengthy transport times.  This simple to administer and inexpensive treatment can save lives.

Pre-referral rectal artesunate to prevent death and disability in severe malaria: a placebo controlled trail

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