# \[e-med\] L'artesunate intra-rectale est aussi efficace que la quinine IV

**URL:** <https://talk.edrugplus.org/t/e-med-lartesunate-intra-rectale-est-aussi-efficace-que-la-quinine-iv/19634>\
**Category:** e-med\
**Created:** [May 18, 2004, 10:49am UTC](https://talk.edrugplus.org/t/e-med-lartesunate-intra-rectale-est-aussi-efficace-que-la-quinine-iv/19634 "2004-05-18T10:49:26Z")\
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**Author:** ![system](https://europe1.discourse-cdn.com/flex013/uploads/edrugplus/original/1X/bada12e9446d722ef85174f465485885b4583977.png) [@system](https://talk.edrugplus.org/u/system)\
**Post date:** [May 18, 2004, 10:49am UTC](https://talk.edrugplus.org/t/e-med-lartesunate-intra-rectale-est-aussi-efficace-que-la-quinine-iv/19634/1 "2004-05-18T10:49:26Z")

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E-MED:L'artesunate intra-rectale est aussi efficace que la quinine IV  
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Un article du LANCET nous informe que l'art�sunate intra-rectale est aussi  
efficace que la quinine intra-veineuse comme premi�re th�rapie d'urgence  
chez les personnes atteintes de paludisme grave et incapables d'absorber un  
m�dicament par voie orale (voir r�f�rences ci-dessous). Il faut noter que  
l'administration d'art�sunate intra-rectale doit �tre suivie d'une th�rapie  
par voie orale d'art�sunate ou autre antipaludique d�s que le patient est  
capable de l'absorber.

L'art�sunate et d'autres d�riv�s de l'art�misinine sont d�j� disponibles sur  
le march� asiatique pour une administration intra-rectale, sous forme de  
suppositoire ou de g�lules molles (Rectocap, Laboratoires Mepha). Par  
contre, les �tudes cliniques sont rares ou doivent �tre compl�t�es.

Sanofi a valid� une formulation intra-rectale de quinine, bas�e sur  
l'ampoule de Quinimax. Pour ces formulations bas�es sur une forme liquide,  
la bio-disponibilit� est tr�s variable, et il est n�cessaire de travailler  
sur des formulations pharmaceutiques intra-rectrales �vitant une perte trop  
importante de principe actif (gel ou suppositoire stable en zone tropicale).

Pascal Millet  
Universit� VIctor Segalen Bordeaux2

E-DRUG: rectal artesunate works as good as IV quinine  
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[Important evidence for malaria cases unable to swallow, who now often get  
an IV drip with quinine: rectal artesunate is equally effective as a startup  
therapy. Please note rectal artesunate needs to be followed by oral  
artesunate AND another drug.  
Rectal artesunate is however not yet prequalified: only oral artesunate from  
Sanofi is prequalified. Will Sanofi or another manufacturer be prepared to  
get a rectal form prequalified soon? Malaria also kills millions... Coped as  
fair use; thanks to Druginfo for spotting this. Full article freely  
downloadable:  
[http://www.thelancet.com/journal/vol363/iss9421/full/llan.363.9421.original\_](http://www.thelancet.com/journal/vol363/iss9421/full/llan.363.9421.original_)  
research.29573.1 WB]

Efficacy of rectal artesunate compared with parenteral quinine in  
initialtreatment of moderately severe malaria in African children and  
adults: arandomised study  
K I Barnes, J Mwenechanya, M Tembo, H McIlleron, P I Folb, I Ribeiro, F  
Little, M Gomes, M E Molyneux

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Division of Pharmacology (K I Barnes MD, F Little PhD, H McIlleron MD, Prof  
P I Folb FRCP), and Department of Statistical Sciences (F Little),  
University of Cape Town, South Africa; Malawi-Liverpool-Wellcome Trust  
Clinical Research Programme and Malaria Project, College of Medicine,  
Blantyre, Malawi (J Mwenechanya MD, M Tembo MD, Prof M E Molyneux FRCP);  
Department of Paediatrics, College of Medicine, University of Malawi, Malawi  
(J Mwenechanya, M Tembo); UNDP/World Bank/WHO Special Program for Research  
and Training in Tropical Diseases (I Ribeiro MD, M Gomes PhD); and School of  
Tropical Medicine, University of Liverpool, UK (M E Molyneux)

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Correspondence to: Prof M E Molyneux, Box 30096, Blantyre 3, Malawi  
(e-mail:mmolyneux@malawi.net)

Summary

Background

Many patients with malaria of increasing severity cannot take medicines  
orally, and delay in injectable treatment can be fatal. We aimed to assess  
the reliability of absorption, antimalarial efficacy, and tolerability of a  
single rectal dose of artesunate in the initial management of moderately  
severe falciparum malaria.

Methods

109 children and 35 adults were randomly assigned to rectal artesunate  
(single dose of about 10 mg/kg) or parenteral quinine treatment (10 mg/kg at  
0, 4, and 12 h). The primary endpoint was the proportion of patients with  
peripheral asexual parasitaemia of less than 60% of that at baseline after  
12 h. Secondary endpoints were clinical response and concentrations of drug  
in plasma. Analysis was by intention-to-treat.

Findings

All artesunate-treated patients had pharmacodynamic or pharmacokinetic  
evidence of adequate drug absorption. 80 (92%) of 87 artesunate-treated  
children had a 12 h parasite density lower than 60% of baseline, compared  
with three of 22 (14%) receiving quinine (relative risk 0�09 [95% CI  
0�04-0�19]; p\<0�0001). In adults, parasitaemia at 12 h was lower than 60% of  
baseline in 26 (96%) of 27 receiving artesunate, compared with three (38%)  
of eight receiving quinine (relative risk 0�06 [0�01-0�44]; p=0�0009). These  
differences were greater at 24 h. Clinical response was equivalent with  
rectal artesunate and parenteral quinine.

Interpretation

A single rectal dose of artesunate is associated with rapid reduction in  
parasite density in adults and children with moderately severe malaria,  
within the initial 24 h of treatment. This option is useful for initiation  
of treatment in patients unable to take oral medication, particularly where  
parenteral treatment is unavailable.

Lancet 2004; 363: 1598-605

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