I was interested to see this letter in this week's Lancet. It emphasises that all children with suspected severe malaria should receive both parenteral artesunate and parenteral antibiotics, but 'unfortunately this advice is often not followed'.
CITATION: Correspondence| volume 400, issue 10355, p807, september 10, 2022
Substantial misdiagnosis of severe malaria in African children
Nicholas J White et al.
Published: September 10, 2022 DOI: https://doi.org/10.1016/S0140-6736(22)01600-2
'WHO has estimated that nearly 2000 African children die each day as a result of severe falciparum malaria, a depressing figure that has changed little since 2015.... Yet there is little research on severe malaria in humans... The only substantial change in policies in recent years has been WHO's ill-advised and unwarranted moratorium on pre-referral rectal artesunate...
'Differentiating severe bacterial infections from severe malaria [in febrile children] is difficult, and the two commonly coexist. For this reason, it is recommended that all children with suspected severe malaria should receive both parenteral artesunate and parenteral antibiotics. Unfortunately this advice is often not followed, or the antibiotics are delayed until the child deteriorates — by which time it might be too late... all children with suspected severe malaria must immediately receive both parenteral artesunate and broad-spectrum antibiotics. In the community, where parenteral drug administration is not possible, pre-referral rectal artesunate should be given. Pre-referral rectal formulations of broad-spectrum antibiotics should be developed.'
Best wishes, Neil
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