Intravenous Artesunate for Treatment of Severe Malaria in the United States

There are approximately 300 cases of severe malaria in the United States each year, most of them acquired from travel to malaria-endemic countries. Severe malaria should be treated with intravenous (IV) antimalarial medications. IV artesunate is the first-line drug for treatment of severe malaria in the United States. Artesunate for InjectionTM manufactured by Amivas, is approved by the FDA and is commercially available in the United States.

FDA-approved artesunate is available for purchase from major drug distributors. Hospitals that do not have Artesunate for InjectionTM in stock should use the following steps when artesunate is needed to treat a patient with severe malaria:

  1. The hospital pharmacist should call +1-855-5AMIVAS (+1-855-526-4827) to identify the closest distributor of Artesunate for InjectionTM for a patient emergency.  This number operates 24/7/365. If prompted, the hospital pharmacist should leave a voice message with a call back phone number. All voice messages with a contact phone number will receive a call back within 30 minutes.
  2. Another option is to call the emergency line for the hospital’s affiliated distributor. Information and emergency phone numbers for distributors that carry Artesunate for InjectionTM can be found here. *Make sure to emphasize that this is an emergency procurement for a critically ill patient.

If it is not possible to obtain drug from a distributor immediately, consider obtaining drug from a nearby hospital that has it in stock (this can be facilitated by a prearranged agreement), or transferring the patient to a hospital where artesunate is stocked or can be procured more quickly. Treat the patient with oral antimalarials while waiting for IV artesunate to arrive. Options include artemether-lumefantrine (Coartem®) (preferred), atovaquone-proguanil (MalaroneTM), or quinine. Once the IV artesunate arrives, start the IV artesunate and discontinue the oral antimalarial.

The indications for IV artesunate include the following:

  • Malaria confirmation by microscopy.


  • Severe malaria based on at least one of the following:
    • High percent parasitemia (≥5%)
    • Impaired consciousness
    • Seizures
    • Circulatory collapse/shock
    • Pulmonary edema or acute respiratory distress syndrome (ARDS)
    • Acidosis
    • Acute kidney injury
    • Abnormal bleeding or disseminated intravascular coagulation (DIC)
    • Jaundice (must be accompanied by at least one other sign)
    • Severe anemia (Hb <7 g/dL)


  • Inability to take oral medications despite attempt after an oral antiemetic