Randomized comparison of mefloquine-artesunate versus quinine in the treatment of multidrug-resistant falciparum malaria in pregnancy

Since no effective malaria prevention measures have been identified for pre gnant women living on the western border of Thailand, prompt diagnosis and efficient treatment are paramount, although drug resistance in Plasmodium f alciparum has narrowed the treatment options. An open randomized comparison of supervised quinine (10 mg salt/kg every 8 h) for 7 days (Q7) versus mef loquine 25 mg base/kg (total dose) plus artesunate 4 mg/kg per day for 3 da ys (MAS3) was conducted in 1995-97 in 108 Karen women with acute uncomplica ted falciparum malaria in the second or third trimesters of pregnancy. The MAS3 regimen was more effective than the 47 regimen: day 63 cure rates were 98.2% (95% CI 94.7-100) (n = 65) for MAS3 and 67.0% (95% CI 43.3-90.8) (n = 41) for Q7, P= 0.001. The MAS3 regimen was also associated with less game tocyte carriage; the average person-gametocyte-weeks for MAS3 was 2.3 (95% CI 0-11) and for 47 was 46.9 (95% CI 26-78) per 1000 person-weeks, respecti vely (P < 0.001). MAS3 was significantly better tolerated. These evident ad vantages must be balanced against a possible increased risk of stillbirth w ith the use of mefloquine in pregnancy. Further randomized studies assessin g the safety and efficacy of other artemisinin-containing combination regim ens in pregnancy are needed urgently.