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Prompt start of parenteral antimalarial is essential. The antimalarial treatment of severe disease is being transformed by the development and deployment of the watersoluble artemisinin derivative artesunate. Parenteral artesunate is now the treatment of choice in low-transmission areas and in the 2nd and 3rd trimesters of pregnancy, and research is underway into whether it should replace quinine as the treatment of choice in African children. The development of artesunate suppositories may provide the means to treat patients with severe disease in remote rural settings, potentially buying the time needed to reach a health care facility.

Therapeutic approaches to severe and cerebral malaria and design of trials