WHO issues information note on correct use of rectal artesunate for severe malaria

Note includes considerations for large-scale deployment of quality-assured rectal artesunate

18 Dec 2017

MMV welcomes the information note on ‘Rectal artesunate for pre-referral treatment of severe malaria’ recently released by the World Health Organization (WHO)

The aim of the note is to prepare countries for large-scale deployment of rectal artesunate (RAS) for pre-referral management of severe malaria in children, while reinforcing the importance of using RAS and other artemisinin-containing medicines appropriately.  While appropriate use could save the lives and reduce disability in children with severe malaria, incorrect use of medicines like RAS could increase the risk of artemisinin-resistant malaria in Africa.

Based on current WHO recommendations, this information note describes how to use RAS for pre-referral management of severe malaria in children under 6 years of age in remote areas where comprehensive treatment is not available and intramuscular injections of artesunate cannot be administered.

Since 2005, when WHO first recommended the use of RAS for pre-referral management of young children with severe malaria, no RAS product has met international quality standards. In December 2016 this changed. The Global Fund to Fight AIDS, Tuberculosis and Malaria’s Expert Review Panel (ERP) issued a 12-month authorization for procurement of Cipla’s 100mg RAS for pre-referral management of severe malaria. The authorization, obtained with MMV’s support, allows RAS to be procured with international funding for the first time and has made way for large-scale implementation of the intervention.

“MMV welcomes WHO’s Information note on the correct use of rectal artesunate,” said Dr David Reddy, MMV’s CEO. “Most children who die from malaria live in remote areas, far from healthcare facilities. Rectal artesunate used correctly has the potential to buy time for these vulnerable children, so they can be taken to healthcare facilities and receive appropriate care. The rational use of RAS will undoubtedly save the lives of these children.”

The information note emphasizes important aspects such as the narrow window of time for RAS administration and the need for immediate referral for full WHO-recommended treatment for severe malaria, using injectable artesunate, followed by oral ACTs. It also recommends that only RAS formulations of proven quality should be used, citing the recent addition of Cipla’s 100mg RAS to the Global Fund’s ERP-reviewed list of products for time-limited procurement.