From: Intermittent preventive treatment for malaria in pregnancy in Africa: What's new, what's needed?
Drug | Mode of action | Elimination half life | Advantages/disadvantages |
---|---|---|---|
Artemether | Inhibits falciparum sarcoplasmic-endoplasmic reticulum calcium ATPase | 3 – 7 h (converted to DHA) | Appears safe in the second and third trimester Widely available in a cheap, fixed dose co-formulation with lumefantrine (Coartem©/Riamet©) |
Artemisinin | Inhibits falciparum sarcoplasmic-endoplasmic reticulum calcium ATPase | 2 – 3 h (converted to DHA) | Appears safe in the second and third trimester Fixed dose co-formulations unavailable |
Artesunate | Inhibits falciparum sarcoplasmic-endoplasmic reticulum calcium ATPase | 2 – 5 mins (converted to DHA) | Appears safe in the second and third trimester Fixed dose co-formulations unavailable |
Atovaquone | Selective inhibitor of parasite mitochondrial metabolism | 48 – 72 h | Appears safe in the third trimester Available only in fixed dose co-formulation with proguanil (Malarone©), which is expensive outside specific donation programmes |
Azithromycin | Exact mode of action unknown | 68 h | Safe in all trimesters where has been used extensively in STI treatment Expensive; fixed dose co-formulations unavailable |
Chlorproguanil | Folic acid antagonist (inhibits dihydrofolate reductase) | 32 h | Cheap; appears safe in the third trimester and likely to be safe earlier in pregnancy based on experience with proguanil Available only in fixed dose co-formulation with dapsone (Lapdap©), which WHO have recommended be used with caution in areas of high G6PD deficiency |
Dapsone | Folic acid antagonist (inhibits dihydropteroate synthase) | 31 h | Cheap; appears safe in the third trimester Available in fixed dose co-formulation with chlorproguanil (Lapdap©), which WHO have recommended be used with caution in areas of high G6PD deficiency |
Dihydroartemisinin (DHA) | Inhibits falciparum sarcoplasmic-endoplasmic reticulum calcium ATPase | 40 – 60 mins | Likely to be safe in the second and third trimester Available in SE Asia, China in a cheap fixed dose co-formulation with piperaquine (Artekin©/Eurartekin©) |
Lumefantrine | Inhibits metabolism of haem within parasite acid food vacuole | 4 – 6 days | Safety in children and adults established but no data available in pregnancy Widely available in a cheap [through WHO pricing agreement], fixed dose co-formulation with artemether (Coartem©/Riamet©) |
Mefloquine | Exact mode of action unknown | 2 – 4 weeks | Appears safe in the second and third trimester Expensive; fixed dose co-formulations unavailable |
Piperaquine | Inhibits detoxification of haem | 3 – 4 weeks | Safety in children and adults established but no data available in pregnancy Available in SE Asia, China in a cheap, fixed dose co-formulation with dihydroartemisinin (Artekin©/Eurartekin©) |
Proguanil | Folic acid antagonist (inhibits dihydrofolate reductase) | 12 – 21 h | Cheap; appears safe in all trimesters Available alone or in fixed dose co-formulation with atovaquone (Malarone©), which is expensive outside specific donation programmes |
Pyrimethamine | Folic acid antagonist (inhibits dihydrofolate reductase) | 100 h | Cheap; widely available in fixed-dose combination with sulphadoxine Increasing resistance particularly in East Africa |
Sulphadoxine | Folic acid antagonist (inhibits dihydropteroate synthase) | 200 h | Cheap; widely available in fixed-dose combination with pyrimethamine Increasing resistance particularly in East Africa |