Reviewed: January 2022

• Non-formulary for the following reasons:
  • Rare use (rare cases of severe malaria)
  • Concern about stocking drug and supplement waste

Notes: Initial treatment course for an average weight patient (6 vials) of non-formulary IV artesunate is stocked at OMC-Jeff Hwy for emergency use across the system (to avoid the 24-hour delay when procuring initial doses through the expedited manufacturer pathway):

Criteria of use: Use only in severe malaria

I. Infectious Disease Service Line or System Antimicrobial Stewardship Team

ii. Malaria confirmed by microscopy AND

iii. Positive diagnosis of Severe Malaria (at least one of the following) OR persistent inability to tolerate oral antimalarial medication

1. 1. Parasite density ≥ 5%
   2. Impaired consciousness
   3. Seizures
   4. Shock
   5. Pulmonary edema or acute respiratory distress syndrome (ARDS)
   6. Acidosis
   7. Acute kidney injury
   8. Abnormal bleeding or disseminated intravascular coagulation
   9. Hemoglobin < 7 g/d

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