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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
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 daysa 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
  1. 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
  2. NA not applicable
  3. 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)
  4. a Quinine given for 3 days, except for infections acquired in Southeast Asia where 7 days of treatment is required
  5. * Under directly observed therapy
  6. ** Directly observed therapy is not undertaken
  7. *** 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
  8. 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
  9. 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
  10. Geographically sub-Saharan African countries although these are members of the Arab League as well
  11. # Greater Mekong Sub-region; (President’s Malaria Initiative-supported countries)
  12. § Sub-Saharan African countries (President’s Malaria Initiative-supported countries)
  13. $ AL is given at a dose and duration similar to that of adult patients (see Table 3)
  14. – Not included in the relevant guidelines or the operational malaria plan