From the Guidelines
For a primi 7 mth with PF POSITIVE MALARIA TREATMENT, artemether-lumefantrine (AL) is the recommended treatment option, as it has been shown to be effective and safe in the treatment of uncomplicated malaria during the second and third trimesters of pregnancy 1. The treatment regimen for artemether-lumefantrine consists of 20/120 mg tablets, with a total of 24 tablets given over 3 days: 4 tablets twice daily for 3 days, taken with fatty food to enhance absorption. Key considerations for treatment include:
- Monitoring for treatment response with follow-up blood smears
- Supportive care including antipyretics, adequate hydration, and close monitoring of fetal wellbeing
- Provision of insecticide-treated bed nets for ongoing prevention It is essential to initiate treatment immediately, as malaria in pregnancy carries significant risks, including maternal anemia, miscarriage, stillbirth, premature delivery, and low birth weight 1. Alternative treatment options, such as dihydroartemisinin-piperaquine or artesunate-amodiaquine, may be considered if artemether-lumefantrine is unavailable. However, the current evidence supports artemether-lumefantrine as the preferred treatment option for uncomplicated malaria in pregnant women during the second and third trimesters 1.
From the FDA Drug Label
Quinine crosses the placenta with measurable blood concentrations in the fetus. In studies in which more than 893 pregnant women were treated with quinine for malaria in the first trimester, no quinine-associated increases in the incidence of congenital anomalies were observed compared with other antimalarial drugs A retrospective study of women with P falciparum malaria who were treated with oral quinine sulfate 10 mg/kg 3 times daily for 7 days at any time in pregnancy reported no significant difference in the rate of stillbirths at >28 weeks of gestation in women treated with quinine
The treatment for a primigravida at 7 months gestation with a positive malaria test is quinine sulfate. The recommended dose is 10 mg/kg 3 times daily for 7 days. However, it is crucial to monitor glucose levels in pregnant women taking quinine due to the increased risk of hypoglycemia. Additionally, pregnant women are at risk for a rare triad of complications: massive hemolysis, hemoglobinemia, and hemoglobinuria. 2
From the Research
Treatment for Primigravida with Positive Malaria Test
- For a primigravida (first-time pregnant woman) at 7 months gestation with a positive malaria test, the treatment options are limited due to the risks associated with certain antimalarial drugs during pregnancy 3.
- According to the available evidence, for uncomplicated malaria during the second and third trimester, an artemisinin-based combination therapy (ACT) known to be effective in the region or artesunate and clindamycin for 7 days or quinine and clindamycin can be used as first-line treatment 3.
- It is essential to note that the treatment should not be delayed and should be started immediately with the most readily available drug 3.
- In cases of severe malaria, parenteral artesunate is preferred over quinine in the second and third trimester 3.
- The use of triple artemisinin-based combination therapies (TACTs) has also been explored as a potential treatment option for uncomplicated Plasmodium falciparum malaria, including in areas with artemisinin and ACT partner-drug resistance 4, 5.
- However, the safety and efficacy of TACTs in pregnant women, particularly primigravidas, need to be further evaluated 4, 5.
Key Considerations
- The treatment of malaria in pregnancy requires careful consideration of the potential risks and benefits of different antimalarial drugs 6, 3.
- The use of insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) are recommended for the prevention of malaria in pregnancy in stable transmission settings 3.
- It is crucial to follow the guidelines for the treatment of malaria in pregnancy and to consult with a healthcare professional for personalized advice 3.