Artesunate suppositories are used for the treatment of
malaria
Malaria is a Mosquito-borne disease, mosquito-borne infectious disease that affects vertebrates and ''Anopheles'' mosquitoes. Human malaria causes Signs and symptoms, symptoms that typically include fever, Fatigue (medical), fatigue, vomitin ...
. Artesunate is an antimalarial water-soluble derivative of
dihydroartemisinin.
Artemisinins are
sesquiterpene lactone
Sesquiterpene lactones (SLs) are a class of sesquiterpenoids that contain a lactone ring. They are most often found in plants of the family Asteraceae (daisies, asters). Other plant families with SLs are Umbelliferae (celery, parsley, carrots) ...
s isolated from ''
Artemisia annua'', a
Chinese traditional medicine. These
suppositories
A suppository is a dosage form used to deliver pharmaceutical drug, medications by insertion into a body orifice (any opening in the body), where it dissolves or melts to exert local or systemic effects. There are three types of suppositories, eac ...
are
given rectally due to the risk of death from severe malaria, as described below.
The risk of death from severe malaria is largely dependent on the time lag between the onset of symptoms and treatment. Rapid access and administration of effective treatment is therefore essential. For many patients, readily available oral drugs cannot be taken because of their symptoms (e.g., vomiting, convulsions, coma), and hospitals providing alternative, non-oral treatment are often inaccessible. The drug artesunate, given in rectal suppository form, provides a potential solution to this problem: it can be made available in remote areas and thus can be given at the onset of symptoms.
Artesunate is one of a number of artemisinin derivatives discovered and developed by Chinese scientists and registered in China since the 1980s. Since the 1990s, UNICEF/UNDP/World Bank/
WHO Special Programme for Research and Training in Tropical Diseases (TDR) have supported studies to assess the properties of the drug. There were already indications that artesunate, given rectally, was effective in severe malaria. Significant work with artemisinin suppositories in severe malaria was conducted in
Viet Nam in the early 1990s, and clinical trials of rectal artesunate followed by mefloquine treatment in moderately severe malaria were conducted in the mid-1990s in
Thailand
Thailand, officially the Kingdom of Thailand and historically known as Siam (the official name until 1939), is a country in Southeast Asia on the Mainland Southeast Asia, Indochinese Peninsula. With a population of almost 66 million, it spa ...
.
A major placebo-controlled clinical trial published in 2009 found that "if patients with severe malaria cannot be treated orally and access to injections will take several hours, a single inexpensive artesunate rectal suppository at the time of referral substantially reduces the risk of death or permanent disability."
[Gomes et al., Pre-referral rectal artesunate to prevent death and disability in severe malaria: a placebo-controlled trial. Lancet, 2009; 373(9663):557-66]
References
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Antimalarial agents
Terpenes and terpenoids