Evidence behind the WHO Guidelines: Hospital Care for Children: Efficacy and Safety of Artemisinin Derivatives in Children with Malaria

This review addresses the question: ‘‘How does the efficacy and safety of artemisinin derivatives compare with quinine in the treatment of severe falciparum malaria in children.’’ The WHO Pocketbook of Hospital Care for Children recommends quinine or artemisinin derivates (artemether or artesunate) for the treatment of severe malaria. Quinine is recommended for most countries except those in Southeast Asia and the Amazon basin. Whatever first-line therapy is used WHO now strongly recommends combination therapy; using an additional drug to which there is no resistance (sulfadoxine-pyrimethamine artemisinin-based combination therapy or clindamycin in combination with quinine). (excerpt)