Artesunate-atovaquone-proguanil rescue treatment of multidrug-resistant Plasmodium falciparum malaria in pregnancy: a preliminary report.
Pregnant women are particularly vulnerable to malaria infections. Multidrug resistance in Plasmodium falciparum seriously compromises treatment in some endemic areas. Between April 1999 and October 2001, we treated and prospectively followed 27 Karen pregnant women with multiple recrudescent P. falciparum infections who were resistant to all other antimalarials with a triple combination of artesunate-atovaquone-proguanil. The treatment was well tolerated and we found no evidence of toxicity for the mothers and the fetus. All but 1 woman were cured (cure rate 96%, 95% CI 89-100). The triple combination of artesunate (4 mg/kg/d), atovaquone (20 mg/kg/d), and proguanil (8 mg/kg/d) may provide a much needed, albeit expensive, 3-d rescue treatment for pregnant women exposed to multidrug- resistant P. falciparum malaria.
Shoklo Malaria Research Unit, Mae Sot, Thailand. shoklo@cscoms.com
Rose
R
McGready
Napaporn Khan
NK
Keo
Leopoldo
L
Villegas
Nicholas J
NJ
White
Sornchai
S
Looareesuwan
François
F
Nosten
D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects; D037621:Artemisinins / Q000008:administration & dosage / Q000009:adverse effects; D000077332:Artesunate; D053626:Atovaquone; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D009285:Naphthoquinones / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy*; D011256:Pregnancy Outcome; D002727:Proguanil / Q000008:administration & dosage / Q000009:adverse effects; D012717:Sesquiterpenes / Q000008:administration & dosage / Q000009:adverse effects
D000962:Antimalarials; D037621:Artemisinins; D009285:Naphthoquinones; D012717:Sesquiterpenes; D000077332:Artesunate; D002727:Proguanil; D053626:Atovaquone