The result of artesunate and mefloquine treatment in pregnant women with quinine resistance Plasmodium falciparum infection

Abstract

Objective to study the result of artesunate and mefloquine treatment in pregnant women with quinine resistance Plasmodium falciparum (P.falciparum) infection.

Method The cases were P. falciparum infected pregnant women who had been treated with quinine for 7 days and still had the parasites in the blood smear during 1 June 1993 to 31 May 1995. The exclusion criteria were cerebral malaria and the patients who did not cooperated. The cases were treated with artesunate 2 mg./kg. loading dose and maintenance with 1 mg./kg. every 12 hours intravenously for 5 days and on the sixth day with mefloquine 15 mg./kg. loading dose and following by 10 mg./kg. 6 hours orally. The cases were studied until they had delivered and the babies had been 12 months old.

Result There were 56 pregnancies with P. falciparum infection, 2 maternal deaths, 15 abortions before 28 weeks, 36 cases were treated with quinine successfully and 3 cases had full-filled inclusion criteria. They were infected with malaria at 10, 27 and 33 weeks. The third case of the study had acute renal failure. All cases developed shock and hypoglycemia. The parasites disappeared from the blood circulation 3 days after treatment and could not be found on the twenty-eighth day of treatment. The intrauterine growth rates were normal. The fetal biparietal diameter and abdominal circumference were also normal. The babies were born at 39,36,39 weeks vaginally and Apgar scores were 9 at 1 minute, 10 at 5 minutes in all cases. No congenital anomalies were detected. Three babies had normal growth and development after they had been followed up for 12 months.

Conclusion The artesunate and mefloquine are useful in treatment of pregnant women who are infected with quinine resistance P. falciparum and they seem to have no harmful effects to the fetus.