(1) Plasmodium falciparum malaria can be fatal in non-immune individuals. Artemisinin derivatives are effective in the treatment of simple malaria attacks, but what is their role in treating severe malaria? (2) It has been estimated that intravenous quinine halves the mortality rate due to malaria. However, it has frequent dose-dependent adverse effects (tinnitus, hearing disorders, dizziness), and carries a risk of rare life-threatening reactions. Intravenous quinine has been a standard treatment for many years; (3) A very large trial has been conducted among adults and children in Southeast Asia. The mortality rate was lower with intravenous artesunate: 15% versus 22% with intravenous quinine. Other, smaller trials have provided similar results. The two treatments have similar adverse effects; (4) In practice, in Southeast Asia, intravenous artesunate has the best risk-benefit balance of the treatments available for severe malaria. Elsewhere, in the absence of parasite resistance, quinine remains the standard treatment. Comparisons with artesunate are awaited.