Editing Malaria (section)

===Severe and complicated malaria===
Cases of severe and complicated malaria are almost always caused by infection with ''P. falciparum''. The other species usually cause only febrile disease.<ref>{{cite journal | vauthors = Kochar DK, Saxena V, Singh N, Kochar SK, Kumar SV, Das A | title = Plasmodium vivax malaria | journal = Emerging Infectious Diseases | volume = 11 | issue = 1 | pages = 132–134 | date = January 2005 | pmid = 15705338 | pmc = 3294370 | doi = 10.3201/eid1101.040519 }}</ref> Severe and complicated malaria cases are medical emergencies since mortality rates are high (10% to 50%).<ref>{{cite journal | vauthors = Pasvol G | title = The treatment of complicated and severe malaria | journal = British Medical Bulletin | volume = 75–76 | pages = 29–47 | date = 2005 | pmid = 16495509 | doi = 10.1093/bmb/ldh059 | doi-access = free }}</ref>

Recommended treatment for severe malaria is the [[Parenteral administration|intravenous]] use of antimalarial drugs. For severe malaria, [[parenteral]] artesunate was superior to quinine in both children and adults.<ref>{{cite web |publisher=Centers for Disease Control and Prevention |date=2022-04-11 |title=Malaria – Diagnosis & Treatment (United States) – Treatment (U.S.) – Artesunate dose 400 mg oral |url=https://www.cdc.gov/malaria/diagnosis_treatment/artesunate.html |access-date=2022-04-25 |language=en-US |archive-date=2016-10-29 |archive-url=https://web.archive.org/web/20161029044719/https://www.cdc.gov/malaria/diagnosis_treatment/artesunate.html |url-status=live }}</ref><ref name="Sinclair-2012" /> In another systematic review, artemisinin derivatives (artemether and arteether) were as efficacious as quinine in the treatment of cerebral malaria in children.<ref>{{cite journal | vauthors = Kyu HH, Fernández E | title = Artemisinin derivatives versus quinine for cerebral malaria in African children: a systematic review | journal = Bulletin of the World Health Organization | volume = 87 | issue = 12 | pages = 896–904 | date = December 2009 | pmid = 20454480 | pmc = 2789363 | doi = 10.2471/BLT.08.060327 | url = https://www.who.int/bulletin/volumes/87/12/08-060327/en/ | url-status = dead | archive-url = https://web.archive.org/web/20160304051023/http://www.who.int/bulletin/volumes/87/12/08-060327/en/ | archive-date = 2016-03-04 }}</ref> Treatment of severe malaria involves supportive measures that are best done in a [[critical care unit]]. This includes the management of [[hyperpyrexia|high fevers]] and the seizures that may result from it. It also includes monitoring for [[respiratory depression|poor breathing effort]], low blood sugar, and [[hypokalemia|low blood potassium]].<ref name="Sarkar-2009" /> Artemisinin derivatives have the same or better efficacy than quinolones in preventing deaths in severe or complicated malaria.<ref>{{cite journal | vauthors = McIntosh HM, Olliaro P | title = Artemisinin derivatives for treating severe malaria | journal = The Cochrane Database of Systematic Reviews | volume = 1998 | issue = 2 | pages = CD000527 | date = 1998-07-27 | pmid = 10796551 | pmc = 6532607 | doi = 10.1002/14651858.CD000527 | collaboration = Cochrane Infectious Diseases Group }}</ref> Quinine [[loading dose]] helps to shorten the duration of fever and increases parasite clearance from the body.<ref>{{cite journal | vauthors = Lesi A, Meremikwu M | title = High first dose quinine regimen for treating severe malaria | journal = The Cochrane Database of Systematic Reviews | volume = 2004 | issue = 3 | pages = CD003341 | date = 2004-07-19 | pmid = 15266481 | pmc = 6532696 | doi = 10.1002/14651858.CD003341.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref> There is no difference in effectiveness when using intrarectal quinine compared to intravenous or intramuscular quinine in treating uncomplicated/complicated falciparum malaria.<ref>{{cite journal | vauthors = Eisenhut M, Omari AA | title = Intrarectal quinine versus intravenous or intramuscular quinine for treating Plasmodium falciparum malaria | journal = The Cochrane Database of Systematic Reviews | volume = 2009 | issue = 1 | pages = CD004009 | date = January 2009 | pmid = 19160229 | pmc = 6532585 | doi = 10.1002/14651858.CD004009.pub3 | collaboration = Cochrane Infectious Diseases Group }}</ref> There is insufficient evidence for intramuscular arteether to treat severe malaria.<ref>{{cite journal | vauthors = Afolabi BB, Okoromah CN | title = Intramuscular arteether for treating severe malaria | journal = The Cochrane Database of Systematic Reviews | volume = 2004 | issue = 4 | pages = CD004391 | date = October 2004 | pmid = 15495107 | pmc = 6532577 | doi = 10.1002/14651858.CD004391.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref> The provision of rectal artesunate before transfer to hospital may reduce the rate of death for children with severe malaria.<ref>{{cite journal | vauthors = Okebe J, Eisenhut M | title = Pre-referral rectal artesunate for severe malaria | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 5 | pages = CD009964 | date = May 2014 | pmid = 24869943 | pmc = 4463986 | doi = 10.1002/14651858.CD009964.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref> In children with malaria and concomitant hypoglycaemia, sublingual administration of glucose appears to result in better increases in blood sugar after 20 minutes when compared to oral administration, based on very limited data.<ref>{{cite journal | vauthors = De Buck E, Borra V, Carlson JN, Zideman DA, Singletary EM, Djärv T | title = First aid glucose administration routes for symptomatic hypoglycaemia | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 4 | pages = CD013283 | date = April 2019 | pmid = 30973639 | pmc = 6459163 | doi = 10.1002/14651858.CD013283.pub2 | collaboration = Cochrane Metabolic and Endocrine Disorders Group }}</ref>

Cerebral malaria is the form of severe and complicated malaria with the worst neurological symptoms.<ref>{{cite journal | vauthors = Idro R, Marsh K, John CC, Newton CR | title = Cerebral malaria: mechanisms of brain injury and strategies for improved neurocognitive outcome | journal = Pediatric Research | volume = 68 | issue = 4 | pages = 267–274 | date = October 2010 | pmid = 20606600 | pmc = 3056312 | doi = 10.1203/pdr.0b013e3181eee738 }}</ref> There is insufficient data on whether osmotic agents such as mannitol or urea are effective in treating cerebral malaria.<ref>{{cite journal | vauthors = Okoromah CA, Afolabi BB, Wall EC | title = Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria | journal = The Cochrane Database of Systematic Reviews | volume = 2011 | issue = 4 | pages = CD004615 | date = April 2011 | pmid = 21491391 | pmc = 4018680 | doi = 10.1002/14651858.CD004615.pub3 | collaboration = Cochrane Infectious Diseases Group }}</ref> Routine phenobarbitone in cerebral malaria is associated with fewer [[convulsion]]s but possibly more deaths.<ref>{{cite journal | vauthors = Meremikwu M, Marson AG | title = Routine anticonvulsants for treating cerebral malaria | journal = The Cochrane Database of Systematic Reviews | volume = 2002 | issue = 2 | pages = CD002152 | date = 2002-04-22 | pmid = 12076440 | pmc = 6532751 | doi = 10.1002/14651858.CD002152 | collaboration = Cochrane Infectious Diseases Group }}</ref> There is no evidence that steroids would bring treatment benefits for cerebral malaria.<ref>{{cite journal | vauthors = Prasad K, Garner P | title = Steroids for treating cerebral malaria | journal = The Cochrane Database of Systematic Reviews | volume = 1999 | issue = 2 | pages = CD000972 | date = 1999-07-26 | pmid = 10796562 | pmc = 6532619 | doi = 10.1002/14651858.CD000972 | collaboration = Cochrane Infectious Diseases Group }}</ref>