Multicenter trials in Southeast Asia have shown better survival rates among patients with severe
malaria, particularly those with high
parasitemia levels, treated with intravenous (IV)
artesunate than among those treated with
quinine. In Europe,
quinine is still the primary treatment for severe
malaria. We conducted a retrospective analysis for 25 travelers with severe
malaria who returned from
malaria-endemic regions and were treated at 7 centers in Europe. All patients survived. Treatment with IV
artesunate rapidly reduced
parasitemia levels. In 6 patients at 5 treatment centers, a self-limiting episode of unexplained
hemolysis occurred after reduction of
parasitemia levels. Five patients required a
blood transfusion. Patients with posttreatment
hemolysis had received higher doses of IV
artesunate than patients without
hemolysis. IV
artesunate was an effective alternative to
quinine for treatment of
malaria patients in Europe. Patients should be monitored for signs of
hemolysis, especially after parasitologic cure.