Management of a case of chloroquine-resistant falciparum malaria in a pregnant woman with glucose-6-phosphate dehydrogenase (G6PD) deficiency

The available antimalarial drugs for the treatment of Plasmodium falciparum malaria during pregnancy are potentially toxic, expecially in the presence of red blood cells (RBC) defects. We describe a case of chloroquine-resist ant malaria by P. falciparum in a pregnant woman with glucose-6-phosphate d ehydrogenase (C6PD) deficiency successfully treated with pyrimethamine foll owed by mefloquine administration. The susceptibility of P. falciparum to c hloroquine and mefloquine was assessed by an in vitro test before treatment . Pyrimethamine and mefloquine were administered at the 18th and 22nd week of pregnancy, respectively. Mefloquine concentrations were monitored in the mother's blood at 2, 4, 8, 12, 24 and 48 hr after the administration to de fine effective blood-drug concentrations. Blood smear examination was negat ive after 48 hr post mefloquine treatment. No hystologic lesions of the pla centa were observed. The newborn presented normal clinical parameters. The administration of pyrimethamine prevented massive placental infection, thus permitting the fetus to achieve suitable gestational age for further treat ment with mefloquine to eradicate P. falciparum malaria without deleterious effects to the newborn. Subsequent studies could contribute to define safe administration of mefloquine in G6PD-deficient pregnant woman.