BMJ  2005;331:1025 (29 October), doi:10.1136/bmj.331.7523.1025-a

Letter

Proposed guidelines for severe imported malaria in children need more evidence

The first 150 words of the full text of this article appear below.

EDITOR—The proposed UK guidelines for severe childhood malaria are an excellent attempt to improve the care of children with severe imported malaria,1 but we are concerned about the following.

Firstly, the use of parenteral antibiotics. The "high risk group" would include less than 5% of children with imported malaria.2 Children with these features in the United Kingdom are likely to have bacterial septic shock or meningitis, even with a history of foreign travel. Furthermore, it is impossible to differentiate between septic shock or meningitis and severe malaria.3 4 The management algorithm should, therefore, recommend giving empirical broad spectrum antibiotics to children with high risk criteria until bacterial infection can be excluded.

Secondly, transfusion. The authors propose that children with haemoglobin counts < 100 g/l should be managed in a high dependency unit and be transfused. In east London 65/211 (31%) presented with haemoglobin counts of 50-100 g/l, and none . . . [Full text of this article]

Shamez Ladhani, research fellow, paediatric infectious diseases

DrShamez@aol.com
Academic Centre for Child Health, Royal London Hospital, London El 2AX

Delane Shingadia, senior lecturer, paediatric infectious diseases

Academic Centre for Child Health, Royal London Hospital, London El 2AX

F Andrew I Riordan, consultant, paediatric infectious diseases and immunology

Royal Liverpool Children's Hospital (Alder Hey), Eaton Road, Liverpool L12 2AP


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Relevant Article

Management of severe malaria in children: proposed guidelines for the United Kingdom
Kathryn Maitland, Simon Nadel, Andrew J Pollard, Thomas N Williams, Charles R J C Newton, and Michael Levin
BMJ 2005 331: 337-343. [Extract] [Full Text] [PDF]

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