Giving pregnant women with malaria a drug called amodiaquine is a safe and effective treatment, according to the results of an African trial published in this week's issue of The Lancet.
Chloroquine and sulphadoxine-pyrimethamine (SP) are the safest and most readily available drugs for the treatment and prevention of malaria in pregnancy in most African countries. However, the parasite that causes malaria is becoming resistant to these drugs. Most countries are adopting artesunate-based combination therapy (ACT) as the preferred treatment of malaria but little is known about its safety in pregnant women.
Amodiaquine is effective in some areas of chloroquine resistance. The researchers assessed whether amodiaquine alone or in combination was a safe and effective drug option for malaria treatment in pregnancy until the safety of ACTs in pregnancy has been established.
The researchers compared the effect of four different regimens - chloroquine, SP, amodiaquine, and amodiaquine plus SP, on malaria in pregnant women. 900 pregnant women with a gestational age of 16 weeks or more were enrolled onto the trial in a hospital in Ghana. The participants were assessed at regular intervals up to 28 days after start of treatment for parasitological failure, which is the need for medication before day 28 or presence of the parasite at day 28. Parasitological failure by day 28 was 14%, 11%, 3%, and 0% in the women assigned chloroquine, SP, amodiaquine, and amodiaquine plus SP, respectively. No serious side-effects were reported.
The authors conclude: "Amodiaquine alone or in combination with sulphadoxine-pyrimethamine, although associated with minor side-effects, is effective when used to treat malaria in pregnancy."
See also accompanying Comment.
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Contact: Dr Harry Tagbor, St Theresa's Hospital, PO Box 30, Nkoranza–B/A, Ghana T) +233 244 417701 Harry.Tagbor@lshtm.ac.uk
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Journal
The Lancet