Artesunate Dosing in Severe Falciparum Malaria

TO THE EDITOR—In the past 6 years the largest ever randomized controlled trials in severe falciparum malaria have been reported [1, 2]. Compared with quinine, parenteral artesunate reduced mortality by 22.5% (from 10.9% to 8.5%) in African children (N = 5425) and by 35% (from 22% to 15%) in Southeast Asian patients (N = 1461, of whom 202 were children). The artesunate dose evaluated in the AQUAMAT and SEAQUAMAT trials and now recommended by the World Health Organization (WHO) was 2.4 mg/kg, given twice on the day of admission, followed by 2.4 mg/kg once daily. The 2.4 mg/kg intravenous artesunate dose corresponds approximately to the widely used oral dose of 4 mg/kg per day, which gives maximal parasite clearance rates against sensitive parasites [3]. Kremsner et al [4] now report a comparison of a once daily 4 mg/kg intravenous artesunate dose with the WHO-recommended regimen in African children hospitalized with malaria. Despite the