Standby Emergency Treatment of Malaria in Travelers

Experience to Date and New Developments

Patricia Schlagenhauf; Eskild Petersen

Disclosures

Expert Rev Anti Infect Ther. 2012;10(5):537-546. 

In This Article

SBET in Pregnancy

Malaria in pregnant women is a potential life-threatening condition, and concerns for potential side effects are overruled by the concern for the life of the pregnant mother. Therefore, if malaria is suspected, the pregnant women should be treated with an effective drug. The WHO guidelines recommend clindamycin and quinine as the most appropriate treatment for pregnant women in the first trimester, and for the second and third semesters the artemisinin combinations can be used. Use of mefloquine treatment in the first trimester was associated with an increased risk of stillbirths in Thailand but not in a controlled study in Malawi.[25,26] A recent database analysis of women exposed to mefloquine in the periconception and first trimester showed no increased risk of fetal loss or malformations,[27] but these women were using mainly chemoprophylactic doses. Recent guidelines from the CDC consider the use of mefloquine in the first trimester to be safe.[104]

Artemisinins are considered safe in the second and third trimester of pregnancy. Data are accumulating on ACT treatment in pregnancy with more than 1500 documented reports of treatments in the second and third trimester, with no elevated risk of adverse outcomes.[28] Currently, there is insufficient evidence (154 cases) to recommend DHA + PPQ (Eurartesim®) in pregnancy.[29,30,33] One study indicates that pregnant women have an increased clearance of artemisinins,[29] but safety data in the first trimester are lacking and are now urgently needed with the roll out of artemisinin combinations.

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