Volume 11 Supplement 1

Challenges in malaria research

Open Access

Safety and efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria during pregnancy: a systematic review

  • Christine Manyando1,
  • Kassoum Kayentao2,
  • Umberto D’Alessandro3,
  • Henrietta U Okafor4,
  • Elizabeth A Juma5 and
  • Kamal Harried6
Malaria Journal201211(Suppl 1):O39

DOI: 10.1186/1475-2875-11-S1-O39

Published: 15 October 2012

Background

Malaria during pregnancy, especially Plasmodium falciparum malaria, is linked to increased morbidity and mortality, which must be reduced by preventive measures and effective case management [13]. The World Health Organization (WHO) recommends artemisinin-based combination therapy (ACT) to treat uncomplicated P. falciparum malaria during the second and third trimesters of pregnancy, and quinine plus clindamycin during the first trimester [4]. However, the national policies of many African countries currently recommend quinine throughout pregnancy. Therefore, the objective is to provide a summary of available data on the safety and efficacy of artemether-lumefantrine (AL) in pregnancy.

Materials and methods

A systematic English-language research identified 16 publications from 1989 to October 2011 with reports of artemether or AL exposure in pregnancy, including randomized clinical trials, observational studies, and systematic reviews.

Results

Overall, there were 1,103 reports of AL use in pregnant women: 890 second/third trimester exposures; 212 first trimester exposures; and 1 case where the trimester of exposure was not reported. In the second and third trimesters, AL was not associated with increased adverse pregnancy outcomes compared with quinine or sulphadoxine-pyrimethamine, showed improved tolerability relative to quinine, and its efficacy was non-inferior to quinine. Although, few reports suggest that the pharmacokinetics of anti-malarial drugs may change in pregnancy, the majority of studies reported high cure rates and adequate tolerability. As there are fewer reports of AL safety in the first trimester, additional data are required to assess the potential to use AL in the first trimester.

Conclusions

These findings reinforce the WHO recommendation to treat uncomplicated P. falciparum malaria with quinine plus clindamycin in early pregnancy and ACT in later pregnancy.

Authors’ Affiliations

(1)
Public Health Department, Tropical Diseases Research Centre
(2)
Malaria Research and Training Centre, University of Bamako
(3)
Medical Research Council Unit
(4)
Department of Pediatrics, College of Medicine, University of Nigeria
(5)
Kenya Medical Research Institute
(6)
Novartis Pharmaceuticals Corporation

References

  1. Whitty CJ, Edmonds S, Mutabingwa TK: Malaria in pregnancy. BJOG. 2005, 112: 1189-1195. 10.1111/j.1471-0528.2005.00714.x.View ArticlePubMedGoogle Scholar
  2. van Geertruyden JP, Thomas F, Erhart A, D’Alessandro U: The contribution of malaria in pregnancy to perinatal mortality. Am J Trop Med Hyg. 2004, 71: 35-40.PubMedGoogle Scholar
  3. Menendez C, Romagosa C, Ismail MR, Carrilho C, Saute F, Osman N, Machungo F, Bardaji A, Quinto L, Mayor A, Naniche D, Dobaño C, Alonso PL, Ordi J: An autopsy study of maternal mortality in Mozambique: the contribution of infectious diseases. PLoS Med. 2008, 5: e44-10.1371/journal.pmed.0050044.PubMed CentralView ArticlePubMedGoogle Scholar
  4. Guidelines for the Treatment of Malaria. 2010, World Health Organization, 2

Copyright

© Manyando et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Advertisement