Artemisinin antimalarials in pregnancy: A prospective treatment study of 539 episodes of multidrug-resistant Plasmodium falciparum

The emergence and spread of multidrug-resistant Plasmodium falciparum compr omises the treatment of malaria, especially during pregnancy, where the cho ice of antimalarials is already limited. Artesunate (n = 528) or artemether (n = 11) was used to treat 539 episodes of acute P. falciparum malaria in 461 pregnant women, including 44 first-trimester episodes. Most patients (3 10 [57.5%]) received re-treatments after earlier treatment with quinine or mefloquine. By use of survival analysis, the cumulative artemisinin failure rate for primary infections was 6.6% (95% confidence interval, 1.0-12.3), compared with the re-treatment failure rate of 21.7% (95% confidence interv al, 15.4-28.0; P = .004). The artemisinins were well tolerated with no evid ence of adverse effects. Birth outcomes did not differ significantly to com munity rates for abortion, stillbirth, congenital abnormality, and mean ges tation at delivery. These results are reassuring, but further information a bout the safety of these valuable antimalarials in pregnancy is needed.