Background: Severe malaria is a medical emergency with high mortality in children. Recently, artesunate has replaced quinine as the first–line drug for severe malaria. Present study was undertaken to compare efficacy of quinine and artesunate in the treatment of severe malaria in children. Methods: A randomized clinical trial was conducted among children aged up to 12 years, admitted in the medical college hospital with clinical features of severe malaria (WHO criteria). All the children admitted in Paediatrics ward were diagnosed as Malaria by slide method and QBC Assay and after satisfying WHO criteria for severe malaria. Finally, 60 children were included in the study (30 in the quinine group and 30 in the artesunate group). Results: 60% children were aged 5 years or less and 40% children aged more than 5 years to 12 yrs. 90% children were afebrile within 48 hours after treated with artesunate as compared to 70% after treated with quinine. 90.33% children had parasites cleared within 48% hours with artesunate compared to 73.33% with quinine. 83.33% children were fully conscious within 24 hours in artesunate group compared to 33.33% with quinine for the same duration.Hypoglycaemia, nausea and vomiting (20% each) were the most common toxicities reported with quinine. 10% children complained of tinnitus. Neurotoxicity was reported in 6.66% children in both groups. Except 2 cases of neurotoxicity no other adverse reaction was reported with artesunate.There were 3 deaths (10%) in quinine arm, all death occurred after 48 hours of treatment, compared to 2 deaths (6.66%) in artesunate arm, all death within 24 hours of admission. Overall mortality was 8.33%.Conclusion: Artesunate is more effective than quinine in the treatment of severe malaria among children.