Department of Error

confers a 2•5-8•5-fold increased risk of death in children with severe malaria, and the artemisinins do not have substantial antimicrobial eff ects, the inclusion of children with concomitant invasive bacterial infection in our trial will have diluted the lifesaving benefi t of artesunate over quinine.This dilution might be an important contributor to the lower relative risk of death for artesunate versus quinine in African children (23%) than in Asian adults (35%) since bacteraemia is much less common in adults with severe malaria.The high incidence of concomitant bacterial infection does raise the important question of whether all children with a diagnosis of severe falciparum malaria should also receive a broad-spectrum parenteral antibiotic such as a third-generation cephalosporin.