The treatment of imported malaria in children: an update.

Since the 2010 publication in this journal of a review of the management of imported malaria for U.K. children, new evidence for the treatment of both severe and uncomplicated malaria has been published. This review discusses these new data and expands the scope of the previous review to include non-endemic countries outside of the U.K. The results of the AQUAMAT trial in late 2010 and other studies have prompted the WHO to recommend that intravenous artesunate be used preferentially over quinine for the treatment of severe malaria caused by any Plasmodium species in both adults and children. Oral artemisinin-based combination therapies have also shown equivalent (if not better) efficacy in the treatment of uncomplicated malaria caused by all Plasmodium species (including chloroquine-resistant P vivax) in both adults and children, though there are issues regarding the availability of artemisinin-based combination therapies in many non-endemic countries. In these instances, conventional therapeutic regimens continue to be efficacious. Lastly, the use of primaquine for hypnozoite and gametocyte eradication is discussed.