Mefloquine prophylaxis prevents malaria during pregnancy: a double-blind, placebo-controlled study.
A double-blind, placebo-controlled study of mefloquine antimalarial prophylaxis in pregnancy (> 20 weeks of gestation) was conducted in 339 Karen women living in an area of multidrug-resistant malaria transmission on the Thai-Burmese border. Mefloquine gave > or = 86% (95% confidence interval [CI], 59%-94%) protection against Plasmodium falciparum and complete protection against Plasmodium vivax infections. Mefloquine prophylaxis was well tolerated; use of an initial loading dose (10 mg/kg) was associated with transient dizziness, but there were no other significant adverse effects on the mother, the pregnancy, or infant survival or development (followed for 2 years). Falciparum malaria was associated with maternal anemia and a mean reduction in birth weight in gravidae I, II, and III of 225 g (95% CI, 26-423). Maternal anemia at delivery (hematocrit < 30%) was associated with increased infant mortality: 26% versus 15% (relative risk, 1.9; 95% CI, 1.1-3.2). Mefloquine is safe and effective for antimalarial prophylaxis in the second half of pregnancy.
Nosten
F
F
Shoklo Malaria Research Unit, Mae Sot, Thailand.
ter Kuile
F
F
Maelankiri
L
L
Chongsuphajaisiddhi
T
T
Nopdonrattakoon
L
L
Tangkitchot
S
S
Boudreau
E
E
Bunnag
D
D
White
N J
NJ
D000328:Adult; D000740:Anemia / Q000517:prevention & control; D004311:Double-Blind Method; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008288:Malaria / Q000503:physiopathology / Q000517:prevention & control*; D016778:Malaria, Falciparum / Q000517:prevention & control; D016780:Malaria, Vivax / Q000517:prevention & control; D015767:Mefloquine / Q000009:adverse effects / Q000627:therapeutic use*; D002052:Myanmar / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010920:Placenta / Q000469:parasitology; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D013785:Thailand / Q000453:epidemiology
D015767:Mefloquine