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

Al Khaja, Khalid A. J.; Sequeira, Reginald P.

doi:10.1186/s12936-020-03565-2

Malaria Journal

Table 2 Treatment and chemoprevention of falciparum malaria in pregnancy: international and national guidelines recommendations

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

Guidelines	Treatment of chloroquine-resistant P. falciparum in pregnancy				Malaria chemoprevention in pregnancy
	Uncomplicated		Complicated (severe)		IPTp-SP	Folic acid/day	Concurrent use of CTX + IPTp-SP
	1st trimester	2nd and 3rd trimester	1st trimester	2nd and 3rd trimester	IPTp-SP	Folic acid/day	Concurrent use of CTX + IPTp-SP
WHO 2010 [14]	Oral Q + C for 7 days	ACT (excluding DHA–PPQ)	Parenteral AS; a full course of oral Q + C as F-OT	Parenteral AS; a full course of oral ACT as F-OT	Not included	Not specified	Contra-indicated
WHO 2015 [1]	Oral Q + C for 7 days	ACT (including DHA–PPQ)	Parenteral AS; a full course of oral Q + C as F-OT	Parenteral AS; a full course of oral ACT as F-OT	Recommended	400 µg	Contra-indicated
CDC 2019 [56]	Oral MQ/Q + C for 3 or 7 days^a	MQ/A-L/Q + C	Parenteral AS; a full course of MQ/Q + C as F-OT	Parenteral AS; a full course of oral A-L/Q + C as F-OT	Not included	Not specified	Not included
Africa
Angola^§ [54] 2019	Oral Q for 7 days	AL	Parenteral AS^†	Parenteral AS^‡	Implemented**	5000 µg	Not stated
Benin^§ [54] 2018	Oral Q for 7 days	AL/AS–AQ	Parenteral Q^†	Parenteral Q^‡	Implemented**	400 µg	Not stated
Burkina Faso^§ [54] 2019	Oral Q for 7 days	AL	Parenteral Q^†	Parenteral AS^‡	Implemented*	250 µg	Contra-indicated
Cameroon^§ [54] 2019	Parenteral Q	Parenteral AS	Parenteral Q	Parenteral AS	Implemented*	Up to 5000 µg	Contra-indicated
DRC (Congo)^§ [54] 2018	Oral Q + C for 7 days	AS–AQ/AL	Parenteral Q^†	Parenteral AS^‡	Implemented *	400 µg	Contra-indicated
Côte d’Ivoire^§ [54] 2019	Oral Q for 7 days	AS–AQ/AL/DHA–PPQ	Parenteral Q^†	Parenteral Q^‡	Implemented*	400 µg	Contra-indicated
Ethiopia^§ [54] 2019	Oral Q for 7 days	AL	Parenteral AS^†	Parenteral AS^‡	Not implemented	–	–
Ghana^§ 2018	Oral Q for 7 days	AS–AQ/AL	Parenteral Q^†	Parenteral AS^‡	Implemented**	400 µg	Not stated
Guinea^§ [54] 2018	Oral Q for 7 days	AL/AS–AQ	Parenteral Q^†	Parenteral AS^‡	Implemented*	250 µg	Not stated
Kenya^§ [54] 2018	Oral Q for 7 days	AL	Parenteral AS^†	Parenteral AS^‡	Implemented*	400 µg	Not stated
Liberia^§ [54] 2019	Oral Q for 7 days	AS–AQ/AL	Parenteral AS^†	Parenteral AS^‡	Implemented**	250–400 µg	Not stated
Madagascar^§ [54] 2018	Oral Q for 7 days	AS–AQ	Parenteral AS^†	Parenteral AS^‡	Implemented**	400 µg	Not stated
Malawi^§ [54] 2018	Oral Q + C for 7 days	AL	Parenteral Q^†	Parenteral AS^‡	Implemented*	400 µg	Not stated
Mali^§ [54] 2018	Oral Q for 7 days	AL	Parenteral AS^†	Parenteral AS^‡	Implemented*	400 µg	Not stated
Mozambique^§ [54] 2019	Oral Q for 7 days	AL	Parenteral Q^†	Parenteral AS^‡	Implemented*	1000 µg	Not stated
Niger^§ [54] 2019	Oral Q for 7 days	ACT	Parenteral Q^†	Parenteral AS^‡	Implemented*	Not specified	Not stated
Nigeria^§ [54] 2019	Oral Q + C for 7 days	AL/AS–AQ	Parenteral AS^†	Parenteral AS^‡	Implemented*	Not specified	Not stated
Rwanda^§ [54] 2019	Oral Q for 7 days	AL	Parenteral AS^†	Parenteral AS^‡	Discontinued	–	Not stated
Senegal^§ [54] 2018	Oral Q for 7 days	AL/AS–AQ/DHA–PPQ	Parenteral AS^†	Parenteral AS^‡	Implemented*	400 µg	Not stated
Sierra Leone^§ [54] 2019	Oral Q + C for 7 days	AL	Parenteral AS^†	Parenteral AS^‡	Implemented**	400 µg	Not stated
South Africa [46] 2019	Oral Q + C for 7 days	AL	Parenteral AS^†	Parenteral AS^‡	Not implemented	–	–
Tanzania^§ [54] 2019	Oral Q for 7 days	AL	Parenteral Q^†	Parenteral AS^‡	Implemented*	250 µg	Not stated
Uganda^§ [54] 2019	Oral Q for 7 days	AL	Parenteral Q^†	Parenteral AS^‡	Implemented*	400 µg	Contraindicated
Zambia^§ [54] 2019	Oral Q for 7 days	AL	Parenteral Q^†	Parenteral AS^‡	Implemented**	Low dose (not specified)	Not stated
Zimbabwe^§ [54] 2018	Oral Q + C for 7 days	AL	Oral Q	Oral Q	Implemented*	400 µg	Contraindicated
Eastern Mediterranean
Saudi Arabia [45] 2018	Oral Q + C for 7 days	AL/AS–MQ	Parenteral AS^†	Parenteral AS^‡	NA	–	Contraindicated***
Somalia^§¶ [60] 2016	Oral Q for 7 days/AL^$	AL	Parenteral AS^†	Parenteral AS^‡	Implemented**	250 µg	Not stated
Sudan^§¶ [59] 2017	Oral Q for 7 days	AL/DHA–PPQ	Parenteral Q^†	Parenteral Q/AS^‡	Not implemented	–	–
South-East Asia
Bangladesh [72] 2016	AL/AS–AQ/oral Q + C	AL/AS–AQ	Parenteral AS/Q^†	Parenteral AS^‡	NA	NA	–
Burma^# [54] 2018	Oral Q + C for 7 days	AL	Parenteral AS^†	Parenteral AS^‡	NA^●	NA	–
India[73] 2014	Oral Q for 7 days	AL	Parenteral Q/AS^†	Parenteral AS^‡	NA	NA	–
Sri Lanka [55] 2014	Oral Q + C for 7 days	AL	Parenteral Q^†	Parenteral AS/Q^‡	NA	NA	–
Thailand^# [54] 2018	Oral Q + C for 7 days	DHA–PPQ	Parenteral AS^†	Parenteral AS^‡	NA^●	NA	–
Western Pacific
Cambodia^# [54] 2018	Oral Q for 7 days	DHA–PPQ/AS–MQ	Parenteral AS^†	Parenteral AS^‡	NA^●	NA	–
Malaysia [74] 2013	Oral Q for 7 days	AL/AS–MQ	Parenteral AS^†	Parenteral AS^‡	NA	NA	–

A: artemether; ACT: artemisinin-based combination therapy; AL: artemether-lumefantrine; AS: artesunate; AS–AQ: artesunate-amodiaquine; AS–MQ: artesunate-mefloquine; C: clindamycin; CTX: cotrimoxazole; DHA–PPQ: dihydroartemisinin-piperaquine; DRC: Democratic Republic of the Congo; F-OT: follow-on treatment; IPTp-SP: intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine; MQ: mefloquine; Q: quinine; SP: sulfadoxine-pyrimethamine; SPC: single-pill combination
NA not applicable
NA^● it is not part of a national policy due to potential low (unstable) transmission or prevalence of malaria/no funding allocated for malaria in pregnancy by PMI/resistance to sulfadoxine-pyrimethamine (SP)
^a Quinine given for 3 days, except for infections acquired in Southeast Asia where 7 days of treatment is required
* Under directly observed therapy
** Directly observed therapy is not undertaken
*** ACT regimen containing SP should not be given to HIV-infected pregnant patients receiving cotrimoxazole as this increases the risk of sulfonamide-induced adverse reactions
^† Following parenteral artesunate/quinine at least for 24 h and when the patient becomes able to take oral therapy, a full treatment course of anti-malarial(s) recommended for uncomplicated malaria during the 1st trimester (quinine alone or quinine + clindamycin) is given as follow-on treatment
^‡ Following parenteral artesunate/quinine for at least 24 h and when the patient can take oral therapy, a full course of ACT recommended for uncomplicated malaria during the 2nd and 3rd trimester is given as follow-on treatment
^¶ Geographically sub-Saharan African countries although these are members of the Arab League as well
^# Greater Mekong Sub-region; (President’s Malaria Initiative-supported countries)
^§ Sub-Saharan African countries (President’s Malaria Initiative-supported countries)
^$ AL is given at a dose and duration similar to that of adult patients (see Table 3)
– Not included in the relevant guidelines or the operational malaria plan

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ISSN: 1475-2875

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