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Table 1 Anti-malarial drug treatment recommended by 2015 WHO guidelines for falciparum malaria in pregnancy

From: Drug treatment and prevention of malaria in pregnancy: a critical review of the guidelines

Malaria severity/trimesters First-line treatment Dosage/frequency Alternative options/implementation strategy issues
Uncomplicated malaria in first trimester Quinine (Q) + Clindamycin (C), oral Q: 10 mg/kg twice a day for 7 days
C: 10 mg/kg twice a day for 7 days
Q monotherapy if C is not available or ACT or oral artesunate + C is an alternative if Q + C if not available or fails
Uncomplicated and complicated malaria in second and third trimesters Single pill combination (SPC) of ACT   With respect to AL, it should be administered along with milk or fat-rich meal to enhance its oral bioavailability
Artemether + Lumefantrine (AL) 4 tabs (20 mg + 120 mg) given at 0, 8, 24, 36, 48, and 60 h over 3 consecutive days
Artesunate + Amodiaquine (AS–AQ) 2 tabs (100 mg + 270 mg) given once daily for 3 consecutive days
Dihydroartemisinin + Piperaquine (DHA–PPQ) 4 tabs (40 mg + 320 mg) given once daily for 3 consecutive days
Complicated malaria during all trimesters Parenteral artesunate (AS) 2.4 mg/kg at 0, 12, 24, and 48 h If AS is unavailable, intramuscular artemether should be given, and if this is unavailable, then parenteral Q should be started immediately until AS is obtained. Following parenteral AS, treatment should be completed with a full treatment course of oral Q + C for complicated malaria in first trimester or oral ACT for uncomplicated and complicated malaria in 2nd and 3rd trimesters of pregnancy
Intermittent preventive treatment in pregnancy (IPTp) in moderate-to-high malaria transmission areasa SPC of sulfadoxine-pyrimethamine (SP) 3 tabs (500 mg + 25 mg) given at every scheduled antenatal visit from 2nd trimester at least 1 month apart up to delivery Should be given as directly observed therapy (DOT) along with folic dose reduction (400 µg daily). IPTp is implemented in pregnant women starting as early as possible at beginning of 2nd trimester around 13th week of gestation with SP administered at monthly intervals up to the time of delivery and is contra-indicated in women co-infected with HIV on cotrimoxazole prophylaxis
  1. a Areas characterized by steady prevalence pattern, with little variation from 1year to another and affected population often has high levels of immunity
  2. Parenteral stands for intravenous