In areas where multidrug-resistant Plasmodium falciparum (MDR-TY) is prevalent, only quinine is knownto be safe and effective in pregnant women. On the western border of Thailand, 7 days of supervisedquinine (30 mg/kg daily) cures two-thirds of P falciparum-infected women in the 2nd and 3rd trimestersof pregnancy. Artesunate is effective against MDR-w and the limited data on its use in pregnancysuggest it is safe. An open randomized comparison of supervised quinine (10 mg salt/kg every 8 h) incombination with clindamycin (5 mg/kg every 8 h) for 7 days (QC7) versus artesunate 2 mg/kg per dayfor 7 days (A7) was conducted in 1997-2000 in 129 Karen women with acute uncomplicated falciparummalaria in the 2nd or 3rd trimesters of pregnancy. There was no difference in the day-42 cure ratesbetween the QC7 (n = 65) and A7 (n = 64) regimens with an efficacy of 100% in both, confirmed byparasite genotyping. The A7 regimen was also associated with less gametocyte carriage; the averageperson-gametocyte-weeks for A7 was 3 (95% CI O-19) and for QC7 was 39 (95% CI 21-66) per 1000person-weeks, respectively (P < 0.01). There was no difference in gastrointestinal symptoms betweenthe groups but there was significantly more tinnitus in the QC7 group compared to the A7 group (44.9%vs 8.9%; RR 5.1; 95% CI 1.9-135; P < 0.001). The favourable results with quinine-clindamycin meanthat there is a useful back-up treatment for women with falciparum malaria who experience quinine andartesunate failures in pregnancy. Adherence to the 7-day regimen and cost (US818.50 per treatment) arelikely to be the main obstacles to this regimen.

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Drug, chemotherapy, clindamytin, combinations, falciparum, malaria, Plasmodium, pregnant, quinine, women