A randomized comparison of artesunate-atovaquone-proguanil versus quinine in treatment for uncomplicated falciparum malaria during pregnancy.
BACKGROUND
There is no safe, practical, and effective treatment for pregnant women infected with multidrug-resistant Plasmodium falciparum.


METHODS
We recruited pregnant Karen women in the second or third trimesters of pregnancy who had uncomplicated falciparum malaria for a randomized, open-label trial with a restricted sequential trial design of 7 days of supervised quinine (SQ7) versus 3 days of artesunate-atovaquone-proguanil (AAP).


RESULTS
Eight-one pregnant women entered the study between December 2001 and July 2003; 42 were treated with SQ7 and 39 were treated with AAP. Fever, parasite clearance, and duration of anemia were significantly better with AAP; the treatment failure rate was 7 times lower (5% [2/39] vs. 37% [15/41]; relative risk, 7.1 [95% confidence interval, 1.7-29.2]; P = .001). There were no significant differences in birth weight, duration of gestation, or congenital abnormality rates in newborns or in growth and developmental parameters of infants monitored for 1 year.


CONCLUSIONS
AAP is a well-tolerated, effective, practical, but expensive treatment for multidrug-resistant falciparum malaria during the second or third trimesters of pregnancy. Despite the small number of subjects, our results add to the growing body of evidence that AAP is safe for the mother and the fetus.
McGready
Rose
R
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand.
Ashley
Elizabeth A
EA
Moo
Eh
E
Cho
Thein
T
Barends
Marion
M
Hutagalung
Robert
R
Looareesuwan
Sornchai
S
White
Nicholas J
NJ
Nosten
François
F
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use; D000077332:Artesunate; D053626:Atovaquone; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology; D009285:Naphthoquinones / Q000627:therapeutic use; D018512:Parasitemia / Q000188:drug therapy; D010963:Plasmodium falciparum / Q000254:growth & development*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy* / Q000469:parasitology; D011256:Pregnancy Outcome; D002727:Proguanil / Q000627:therapeutic use; D011803:Quinine / Q000627:therapeutic use; D012717:Sesquiterpenes / Q000627:therapeutic use; D013785:Thailand
D000962:Antimalarials; D037621:Artemisinins; D009285:Naphthoquinones; D012717:Sesquiterpenes; D000077332:Artesunate; D011803:Quinine; D002727:Proguanil; D053626:Atovaquone