QUESTION:

What are the drugs for a pregnant woman who has malaria for the first to third trimester?

ANSWER:

The treatment of malaria in pregnant women has become more challenging in recent years, as many types of malaria are developing resistance to the standard arsenal of drugs. In locations where the dominant form of malaria is still chloroquine-sensitive, chloroquine can be used safely throughout pregnancy.

However, given the high levels of chloroquine-resistance, other drug regimens may be required. Currently, first-line treatment options for uncomplicated malaria caused by Plasmodium falciparum (many strains of which are resistant to chloroquine), is quinine plus clindamycin (doxycycline is contraindicated in pregnant women). In the second and third trimesters, artesunate plus clindamycin can be administered, or the artemisinin-based combination therapy (ACT) commonly used in that region, although some of these combinations, particularly those containing artemether, have limited safety testing in pregnant women. In general, the paucity of controlled, randomized trials has posed a problem to creating safe and effective recommendations for the treatment of malaria in pregnant women.