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 Table of Contents  
EVIDENCE-BASED MEDICINE
Year : 2017  |  Volume : 15  |  Issue : 1  |  Page : 63-65

Malaria in pregnancy: Is artemisinin-based treatment effective and safe?


Department of General Medicine, Christian Medical College, Vellore, India

Date of Web Publication17-Feb-2017

Correspondence Address:
George Abraham
Department of General Medicine, Christian Medical College, Vellore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-4651.200305

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How to cite this article:
Abraham G. Malaria in pregnancy: Is artemisinin-based treatment effective and safe?. Curr Med Issues 2017;15:63-5

How to cite this URL:
Abraham G. Malaria in pregnancy: Is artemisinin-based treatment effective and safe?. Curr Med Issues [serial online] 2017 [cited 2019 Nov 19];15:63-5. Available from: http://www.cmijournal.org/text.asp?2017/15/1/63/200305

Clinical Question: Which artemisinin.based combination therapy is effective and safe in pregnant women with malaria?
Authorsf conclusion: (1) Artemisinin.based combination therapy is effective and safe in pregnancy, with minimal adverse effects, most of which are reversible. (2) The artemether.lumefantrine combination was associated with acceptable treatment efficacy and minimal adverse events. (3) Dihydroartemisinin.piperaquine was associated with best efficacy and acceptable safety profile.



  The Problem Top


Malaria in pregnancy is a major public health concern in endemic areas. The problems associated with malaria in a pregnant woman are an increase in the incidence of anemia-complicating pregnancy and low birthweight. In severe cases, it can lead to fetal loss, infant mortality, and maternal death. It becomes imperative, therefore, to treat malaria adequately with effective medicines during pregnancy.

Current treatment guidelines

The World Health Organization guidelines for treatment of malaria in women in the second or third trimester of pregnancy [1] recommend a 3-day course with either an artemisinin-based combination therapy (ACT) or clindamycin plus a 7-day course of either artesunate or quinine [Box 1].



However, there is limited information regarding the safety, efficacy, and adverse drug effects of the newer ACTs in pregnant women, as most trials in the past have excluded this subset of the population. This study [2] was carried out to address this issue.


  Key Results Top


  1. Cure rates in the four groups:Overall cure rates at day 63 were

    • 94.8% in the artemether–lumefantrine group,
    • 98.5% in the amodiaquine–artesunate group,
    • 99.2% in the dihydroartemisinin–piperaquine group, and
    • 96.8% in the mefloquine–artesunate group.


  2. The cure rate was lower and the parasite clearance was slower in artemether–lumefantrine group as compared to other regimens
  3. The prevalence of placental malaria infection, mean birthweight, the incidence of low birthweight was similar across the treatment groups
  4. Adverse effects: There were ten adverse events probably related to the medication that were reported including anemia, upper abdominal pain, malaise, vomiting, headache, and general weakness. However, all the adverse events were completely reversible, and there was no significant difference in the incidence of adverse events across different treatment groups.


There was higher incidence of asthenia, poor appetite, dizziness, nausea, and vomiting among women treated with mefloquine–artesunate or amodiaquine–artesunate.

The incidence of stillbirths, preterm labor, and congenital malformation was varied between 1.9%–2.8%, 3.4%–10.2%, and 0.8%–2% simultaneously, without any statistical difference across the groups.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Guidelines for the Treatment of Malaria. 3rd ed. Geneva: World Health Organization; 2015. Available from: http://www.apps.whoint/iris/bitstream/10665/162441/1/9789241549127_eng.pdf. [Last accessed on 2015 Apr].  Back to cited text no. 1
    
2.
PREGACT Study Group, Pekyi D, Ampromfi AA, Tinto H, Traoré-Coulibaly M, Tahita MC, et al. Four artemisinin-based treatments in African pregnant women with malaria. N Engl J Med 2016;374:913-27.  Back to cited text no. 2
    




 

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