For treatment, the most frequently used antimalarial drugs are not contraindicated in pregnancy. The World Health Organization recommends that all infected patients living in or traveling from endemic areas be treated with an artemisinin-based regimen for uncomplicated falciparum malaria (Taming, 2016). The CDC (2013c) recommends using atovaquone options are not available or tolerated.
nosed with uncomplicated malaria caused by P vivax, malariae, ovale, and chloroquine-sensitive P aciparum should be treated with chloroquine or hydroxychloroquine. For women infected with multidrug-resistant P aciparum, one irst-line agent for nonpregnant persons is artemether-Iumefantrine. Another primary option is artesunate plus meRoquine or artesunate plus dihydroartemisinin-piperaquine (White, 2015). he PREGACT Study Group (2016) recently compared four artemisinin-based drugs in 3428 pregnant women with falciparum malaria and reported no serious maternal or perinatal adverse efects. Second-line treatment regimens are artesunate; quinine plus either tetracycline, doxycycline, or clindamycin; or atovaquone-proguanii. Chloroquine-resistant P vivax should be treated with meRoquine. Chloroquine-sensitive P vivax or P ovale should be treated with chloroquine throughout pregnancy and then primaquine postpartum. Resistance to all the antimalarial drugs has been reported, including the recently added artemisinin-based compounds.
Treatment regimens for uncomplicated and severe malarial infections in pregnancy are detailed at: ww.cdc.gov/malaria/ diagnosis_treatment. he CDC also maintains a malaria hotline for treatment recommendations (855-856-4713).
Malaria control and prevention relies on chemoprophylaxis when traveling to or living in endemic areas. Vector control is also important. Insecticide-treated netting, pyrethroid insecticides, and D EET -based insect repellent lower malarial rates in endemic areas. hese are well tolerated in pregnancy (Menendez, 2007). If travel is necessary, chemoprophylaxis is recommended.
Chloroquine and hydroxychloroquine prophylaxis is safe and well tolerated in pregnancy. Prophylaxis lowers placental infection rates from 20 percent to 4 percent in asymptomatic infected women in areas without chloroquine resistance (Cot, 1992). For travelers to areas with chloroquine-resistant P aciparum, meRoquine prophylaxis is recommended (Freedman, 2016). One evaluation compared prophylaxis during pregnancy with either sulfadoxine-pyrimethamine or dihydroartemisinin-piperaquine and found the latter to be more efective (Kakuru, 2016). Primaquine and doxycycline are contraindicated in pregnancy, and data are insuicient for atovaquone/proguanil use. The latest chemoprophylaxis regimens for pregnancy can be obtained from the CDC Travelers' Health website at: ww.cdc.gov/malaria/ travelers/drugs.htmi. The CDC also publishes Health Inormation or Intenational Travel (The Yellow Book) at: ww.cdc. gov/yellowbook. For women living in endemic areas, intermittent preventive treatment was found to be superior to intermittent screening with treatmet (Desai, 2015).