Objective: Evaluate WHO guideline for the treatment of severe malaria.

Material and Method: A retrospective study in 41 pediatric patients who were admitted and diagnosed as severe malaria in Somdejtprachaotaksinmaharaj Hospital between July 2003 and June 2006 was performed.

Results: Most patients were older than 5 years (83%). The common clinical features and complications were cerebral malaria (12%), severe anemia (7.3%), metabolic acidosis (7.3%), acute renal failure (4.8%) and pulmonary edema (4.8%). These were not different from other reports. Hypoglycemia and hemoglobinuria were not found. 58.5% of the children were classified as having increased risk of dying. All of them received intravenous artesunate and oral mefloquine with improvement. None of them died. Paracitic clearance time was about 2.6 days, fever clearance time was about 3.4 days and resistant type1 was about 4%.

Conclusion: Intravenous administration of antimalarial drug is essential for the group of children at increased risk of dying and artesunate plus mefloquine is effective.

Keywords: Severe falciparum malaria, Clinical feature, Complications, Treatment