Artesunate-atovaquone-proguanil rescue treatment of multidrug-resistant Plasmodium falciparum malaria in pregnancy: a preliminary report.

Abstract

Pregnant women are particularly vulnerable to malaria infections. Multidrug resistance in Plasmodium falciparum seriously compromises treatment in some endemic areas. Between April 1999 and October 2001, we treated and prospectively followed 27 Karen pregnant women with multiple recrudescent P. falciparum infections who were resistant to all other antimalarials with a triple combination of artesunate-atovaquone-proguanil. The treatment was well tolerated and we found no evidence of toxicity for the mothers and the fetus. All but 1 woman were cured (cure rate 96%, 95% CI 89-100). The triple combination of artesunate (4 mg/kg/d), atovaquone (20 mg/kg/d), and proguanil (8 mg/kg/d) may provide a much needed, albeit expensive, 3-d rescue treatment for pregnant women exposed to multidrug- resistant P. falciparum malaria.

• Authors: Rose McGready, Napaporn Khan Keo, Leopoldo Villegas, Nicholas J White, Sornchai Looareesuwan, François Nosten
• Journal: Transactions of the Royal Society of Tropical Medicine and Hygiene (Trans R Soc Trop Med Hyg) 2003 Sep-Oct Vol. 97 Issue 5 Pg. 592-4 ISSN: 0035-9203 [Print] England
• PMID: 15307434 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Artemisinins
• Naphthoquinones
• Sesquiterpenes
• Artesunate
• Proguanil
• Atovaquone

Topics

• Adolescent
• Adult
• Antimalarials (administration & dosage, adverse effects)
• Artemisinins (administration & dosage, adverse effects)
• Artesunate
• Atovaquone
• Drug Resistance, Multiple
• Drug Therapy, Combination
• Female
• Humans
• Malaria, Falciparum (drug therapy)
• Naphthoquinones (administration & dosage, adverse effects)
• Pregnancy
• Pregnancy Complications, Parasitic (drug therapy)
• Pregnancy Outcome
• Proguanil (administration & dosage, adverse effects)
• Sesquiterpenes (administration & dosage, adverse effects)