Nutritional Advice El Mondo
Objectives:
Malaria in pregnancy affects both the mother and the fetus. However, evidence supporting treatment guidelines for uncomplicated (including asymptomatic) falciparum malaria in pregnant women is scarce and assessed in varied ways. Therefore, this review article has been conducted.
What should be the treatment guidelines for uncomplicated (including asymptomatic) falciparum malaria in pregnant women?
Study design:
This review article included 19 interventional or observational cohort studies assessing the efficacy of artemisinin-based or quinine-based treatments in pregnancy; representing 92% of patients in the literature (4,968 of 5,360 episodes).
The included studies were done between 1995 and 2014 in 10 different countries; 9 studies (comprising 3,813 episodes) were done in sub-Saharan Africa and 10 (comprising 1,155 episodes) in Asia.
Results and conclusions:
The investigators found risk of PCR-corrected treatment failure was higher for the quinine monotherapy [n = 244, adjusted hazard ratio = 6.11, 95% CI = 2.57 to 14.54, p 0.0001] but lower for artesunate-amodiaquine [n = 840, adjusted hazard ratio = 0.27, 95% = 0.14 to 0.52, p 0.0001], artesunate-mefloquine [n = 1028, adjusted hazard ratio = 0.56, 95% = 0.34 to 0.94, p = 0.03] and dihydroartemisinin-piperaquine [n = 872, adjusted hazard ratio = 0.35 to 95% CI = 0.18 to 0.68, p = 0.002] than artemether-lumefantrine (n = 1,278) after adjustment for baseline asexual parasitaemia and parity.
The investigators found the risk of gametocyte carriage on day 7 was higher after quinine-based therapy than artemisinin-based treatment [adjusted odds ratio = 7.38, 95% CI = 2.29 to 23.82].
The investigators concluded efficacy and tolerability of artemisinin-based combination therapies (ACTs) in pregnant women are better than quinine. The lower efficacy of artemether-lumefantrine compared with other ACTs might require dose optimisation.
Original title:
Efficacy and Tolerability of Artemisinin-Based and Quinine-Based Treatments for Uncomplicated Falciparum Malaria in Pregnancy: A Systematic Review and Individual Patient Data Meta-Analysis by Saito M, Mansoor R, […], Guérin PJ.
Link:
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30064-5/fulltext
Additional information of El Mondo:
Find more information/studies malaria and pregnancy right here.