Editing Artesunate (section)

==Medical uses==
Artesunate is the first-line treatment for children or adults with severe malaria,<ref name="WHO Malaria">{{Cite book|vauthors=((World Health Organization))|title=Guidelines for treatment of malaria|series=WHO Guidelines Approved by the Guidelines Review Committee|publisher=World Health Organization|date=April 2015|isbn=9789241549127|edition=3rd|location=Geneva|url=https://www.ncbi.nlm.nih.gov/books/NBK294440/|pmid=26020088|hdl=10665/162441|hdl-access=free}}</ref><ref name="CDC2019">{{cite press release | title=CDC: Artesunate Now First-Line Treatment for Severe Malaria in the United States | website=U.S. Centers for Disease Control and Prevention (CDC) | access-date=6 April 2019 | url=https://www.cdc.gov/globalhealth/newsroom/artesunate.html | date=28 March 2019}}</ref><ref>{{cite web | title=Treatment of Malaria: Guidelines For Clinicians (United States) | website=U.S. Centers for Disease Control and Prevention (CDC) | date=8 February 2009 | url=https://www.cdc.gov/malaria/diagnosis_treatment/clinicians1.html | access-date=30 May 2020}}</ref> usually in combination with another antimalarial drug. There is moderate-quality evidence that treatment with artesunate plus mefloquine is superior to treatment with [[Artesunate/amodiaquine|artesunate plus amodiaquine]] or artesunate plus sulfadoxine-pyrimethamine.<ref>{{cite journal | vauthors = Peixoto HM, Marchesini PB, de Oliveira MR | title = Efficacy and safety of artesunate-mefloquine therapy for treating uncomplicated Plasmodium falciparum malaria: systematic review and meta-analysis | journal = Transactions of the Royal Society of Tropical Medicine and Hygiene | volume = 110 | issue = 11 | pages = 626–636 | date = November 2016 | pmid = 28039388 | doi = 10.1093/trstmh/trw077 | doi-access = free }}</ref> [[Artemisinin-based combination therapy]] may be used by mouth in persons that can tolerate it after 24 hours by injection.{{medcn|date=March 2022}}

Artesunate is preferred over parenteral quinine for severe malaria treatment.<ref name="CDC2012" /> Artesunate was shown to prevent more deaths from severe malaria than quinine in two large multicentre randomized controlled trials from Africa<ref>{{cite journal | vauthors = Dondorp AM, Fanello CI, Hendriksen IC, Gomes E, Seni A, Chhaganlal KD, Bojang K, Olaosebikan R, Anunobi N, Maitland K, Kivaya E, Agbenyega T, Nguah SB, Evans J, Gesase S, Kahabuka C, Mtove G, Nadjm B, Deen J, Mwanga-Amumpaire J, Nansumba M, Karema C, Umulisa N, Uwimana A, Mokuolu OA, Adedoyin OT, Johnson WB, Tshefu AK, Onyamboko MA, Sakulthaew T, Ngum WP, Silamut K, Stepniewska K, Woodrow CJ, Bethell D, Wills B, Oneko M, Peto TE, von Seidlein L, Day NP, White NJ | display-authors = 6 | title = Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial | journal = Lancet | volume = 376 | issue = 9753 | pages = 1647–1657 | date = November 2010 | pmid = 21062666 | pmc = 3033534 | doi = 10.1016/S0140-6736(10)61924-1 }}</ref> and Asia.<ref>{{cite journal | vauthors = Dondorp A, Nosten F, Stepniewska K, Day N, White N | title = Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial | journal = Lancet | volume = 366 | issue = 9487 | pages = 717–725 | year = 2005 | pmid = 16125588 | doi = 10.1016/S0140-6736(05)67176-0 | s2cid = 173027 | doi-access = free }}</ref> A subsequent systematic review of seven randomized controlled trials found this improvement in survival rates to be consistent across all trials.<ref>{{cite journal | vauthors = Sinclair D, Donegan S, Isba R, Lalloo DG | title = Artesunate versus quinine for treating severe malaria | journal = The Cochrane Database of Systematic Reviews | volume = 6 | issue = 6 | pages = CD005967 | date = June 2012 | pmid = 22696354 | pmc = 6532684 | doi = 10.1002/14651858.CD005967.pub4 }}</ref>

Artesunate's efficacy is comparable to that of [[artemether]], another artemisinin derivative, in treating adults for severe malaria caused by ''Plasmodium falciparum'', though artesunate clears more parasites initially.<ref>{{cite journal | vauthors = Phu NH, Tuan PQ, Day N, Mai NT, Chau TT, Chuong LV, Sinh DX, White NJ, Farrar J, Hien TT | display-authors = 6 | title = Randomized controlled trial of artesunate or artemether in Vietnamese adults with severe falciparum malaria | journal = Malaria Journal | volume = 9 | issue = 1 | pages = 97 | date = April 2010 | pmid = 20398339 | pmc = 2873528 | doi = 10.1186/1475-2875-9-97 | doi-access = free }}</ref> Artesunate combination drugs have a number of advantages over artemether-based drugs in terms of its uptake and administration routes and may be more effective in treatment of severe and complicated malaria in children.<ref>{{cite journal | vauthors = Li Q, Weina P | title = Artesunate: The Best Drug in the Treatment of Severe and Complicated Malaria | journal = Pharmaceuticals | volume = 3 | issue = 7 | pages = 2322–2332 | date = July 2010 | pmid = 27713355 | pmc = 4036668 | doi = 10.3390/ph3072322 | doi-access = free }}</ref>

Artesunate is also used to treat less severe forms of malaria when it can be given orally.<ref name="WHO Malaria" /> It has activity against ''[[P. ovale]]'', ''[[Plasmodium malariae|P. malariae]]'', and severe ''[[Plasmodium knowlesi|P. knowlesi]]''.<ref name="WHO Malaria" />

Artesunate + [[sulfadoxine/pyrimethamine]] for treatment of ''[[P. vivax]]'' is not recommended due to high rates of resistance.{{citation needed|date=February 2017}}

While artesunate is used primarily as treatment for malaria, there is some evidence that it may also have some beneficial effects in ''[[Schistosoma haematobium]]'' infection,<ref>{{cite journal | vauthors = Boulanger D, Dieng Y, Cisse B, Remoue F, Capuano F, Dieme JL, Ndiaye T, Sokhna C, Trape JF, Greenwood B, Simondon F | display-authors = 6 | title = Antischistosomal efficacy of artesunate combination therapies administered as curative treatments for malaria attacks | journal = Transactions of the Royal Society of Tropical Medicine and Hygiene | volume = 101 | issue = 2 | pages = 113–116 | date = February 2007 | pmid = 16765398 | doi = 10.1016/j.trstmh.2006.03.003 | s2cid = 1675813 | url = https://hal.ird.fr/ird-00177064/file/Boulanger_artesunate_2007.pdf }}</ref> but has not been evaluated in large randomized trials.

Artesunate is used as the treatment of choice for severe malaria by the [[World Health Organization]] (WHO) over [[quinine]].<ref name="CDC2012" /><ref name="WHO Malaria" />

===Pregnancy===
When given in the second or third trimesters of pregnancy, no artesunate-related adverse pregnancy outcomes have been reported.<ref>WHO (2007). [http://malaria.who.int/docs/mip/artemisinin_compounds_pregnancy.pdf Assessment of the safety of artemisinin compounds in pregnancy] {{webarchive|url=https://web.archive.org/web/20100414125450/http://malaria.who.int/docs/mip/artemisinin_compounds_pregnancy.pdf |date=14 April 2010}}. World Health Organization, Geneva.</ref> However, there is insufficient evidence regarding the safety of artesunate use in the first trimester of pregnancy. The WHO recommends that artesunate use for severe malaria in the first trimester should be based on the individual risks versus benefits. In absence of other viable treatment options, artesunate may be used.{{medcn|date=February 2020}}

===Children===
Artesunate is safe for use in children. Artesunate + sulfadoxine/pyrimethamine should be avoided in the newborns due to sulfadoxine/pyrmethamine effects on bilirubin.<ref name="WHO Malaria" /> Parenteral artesunate dosing for treatment of severe malaria in children less than 20&nbsp;kg should be higher than that of adults in order to increase exposure.<ref name="WHO Malaria" /> When artesunate cannot be given orally or intramuscularly due to an individual's weakness or inability to swallow, rectal administration may be given as pre-referral treatment as long as parenteral administration is initiated after transfer to a more advanced facility.{{medcn|date=February 2020}}