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Original ArticleOpen Access
Randomized Trial of Artesunate and Mefloquine in Comparison with Quinine Sulfate to Treat P. falciparum Malaria Pregnant Women
Bounyasong S 
To compare the effectiveness and safety of quinine sulfate and artesunate with mefloquine
for treating second trimester pregnancy in women who suffered from
Plasmodium falciparum
mala-
ria. The prospective study was done in Srisangwal Hospital, Mae Hong Son, Thailand. Sixty, second to
third trimester pregnant patients with
P. falciparum
infection, were recruited at random. They received
either quinine sulfate 10 mg/kg/day for at least 7 days, 29 women (group I), or oral artesunate 2 mg/kg
as the first dose, 1 mg/kg every 12 hours orally for at least 5 days together with split doses of meflo-
quine, 15 mg/kg and 6 hours later 10 mg/kg orally 1 day after artesunate was stopped, 28 women
(group II). Three cases (5%) were lost to follow-up before delivery, one case in group I and two
cases in group II. After treatment, the mean hematocrit of group I was significantly less than group II
(p
=
0.000). The PCT (parasite clearance time) and FCT (fever clearance time) of group II were
significantly shorter than group I (p
=
0.000). None of the patients in both groups had recrudescences
within 28 days. Group I had more adverse effects than group II. No adverse neurological effects in
pregnancy were found in both groups. The calcification of placenta and IUGR (Intrauterine growth
retard) were not different between the two groups (p
=
0.964, 0.363 respectively). The PCT was not
different between the calcified placenta group and normal placenta group (p
=
0.058), but the TTPP
(Total time of parasite presentation) was (p
=
0.000). TTPP related to low birth weight and low
apgar score at 1 minute might be the cause (p
=
0.000, 0.000 F
=
5.261, 21.627 respectively). TTPP
and PCT related to neonatal blood pH and caused low neonatal blood pH (p
=
0.000, 0.001 F
=
24.351, 11.162 respectively). The physical and neurological development of the babies at 2, 4, 6
and 12 months follow-up, were normal and there were no congenital abnormalities in either group.
TTPP relating to fetal outcome, the longer the TTPP, the worse the fetal outcome, so we should
diagnose early and treat
P. falciparum
malaria in pregnancy to prevent fetal jeopardy. Artesunate with
mefloquine could shorten the PCT more than quinine sulfate in pregnancy, so the fetal outcome was
better than that of quinine sulfate. In cases of prolonged infection before treatment, artesunate
might be the alternative treatment of
P. falciparum
malaria in pregnancy. However, its safety should
be carefully studied further with a larger sample size.
Key word : Artesunate, Quinine, Falciparum Malaria, Pregnancy
for treating second trimester pregnancy in women who suffered from
Plasmodium falciparum
mala-
ria. The prospective study was done in Srisangwal Hospital, Mae Hong Son, Thailand. Sixty, second to
third trimester pregnant patients with
P. falciparum
infection, were recruited at random. They received
either quinine sulfate 10 mg/kg/day for at least 7 days, 29 women (group I), or oral artesunate 2 mg/kg
as the first dose, 1 mg/kg every 12 hours orally for at least 5 days together with split doses of meflo-
quine, 15 mg/kg and 6 hours later 10 mg/kg orally 1 day after artesunate was stopped, 28 women
(group II). Three cases (5%) were lost to follow-up before delivery, one case in group I and two
cases in group II. After treatment, the mean hematocrit of group I was significantly less than group II
(p
=
0.000). The PCT (parasite clearance time) and FCT (fever clearance time) of group II were
significantly shorter than group I (p
=
0.000). None of the patients in both groups had recrudescences
within 28 days. Group I had more adverse effects than group II. No adverse neurological effects in
pregnancy were found in both groups. The calcification of placenta and IUGR (Intrauterine growth
retard) were not different between the two groups (p
=
0.964, 0.363 respectively). The PCT was not
different between the calcified placenta group and normal placenta group (p
=
0.058), but the TTPP
(Total time of parasite presentation) was (p
=
0.000). TTPP related to low birth weight and low
apgar score at 1 minute might be the cause (p
=
0.000, 0.000 F
=
5.261, 21.627 respectively). TTPP
and PCT related to neonatal blood pH and caused low neonatal blood pH (p
=
0.000, 0.001 F
=
24.351, 11.162 respectively). The physical and neurological development of the babies at 2, 4, 6
and 12 months follow-up, were normal and there were no congenital abnormalities in either group.
TTPP relating to fetal outcome, the longer the TTPP, the worse the fetal outcome, so we should
diagnose early and treat
P. falciparum
malaria in pregnancy to prevent fetal jeopardy. Artesunate with
mefloquine could shorten the PCT more than quinine sulfate in pregnancy, so the fetal outcome was
better than that of quinine sulfate. In cases of prolonged infection before treatment, artesunate
might be the alternative treatment of
P. falciparum
malaria in pregnancy. However, its safety should
be carefully studied further with a larger sample size.
Key word : Artesunate, Quinine, Falciparum Malaria, Pregnancy
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