farmakologi
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Current strategies
Anti-malaria for pregnant women
Options for malaria control during pregnancy
• Drugs– Chemoprophylaxis
– Intermittent preventive treatment during pregnancy (IPTp)
– Febrile case management• Insecticide Treated Nets (ITNs)• Prevention and treatment of anemia
– Hematinic supplementation– Nutritional counseling
• Vaccines?
Intermittent preventive treatment (IPTp): an alternative strategy
• Most studied regimen: Sulfadoxine-pyrimethamine (SP) 2 curative courses (3 tablets)– One course during second trimester– One course during third trimester
• Inexpensive• Easily deliverable (can be given under direct
observation)• Safe• Efficacious
Intermittent preventive treatment-- the two dose SP strategy
Weeks of gestation
Conception Birth
20 3010
Course 124-28 wks
Course 230-36 wks
Fetal growth velocity
IPTp with SP: summary of evidence and benefits
• 2 doses of IPT with SP is associated with: – Reduction in 3rd trimester maternal
anemia – Reduction in placental malaria
parasitemia– Reduction in low birth weight
• At least 2 doses required for optimal benefit
• Regimen is safe and well tolerated
Case management of malaria in pregnancy
Safe drugs
• Chloroquine• Quinine / quinidine • Proguanil, chlorproguanil• Pyrimethamine• Sulfonamides• Dapsone (+pyrimethamine=
Maloprim)• Mefloquine (prophylaxis)• Clindamycin (300 mg qid, 5-7
days)• Artemisinins (2nd and 3rd)
Drugs with questionable safety or insufficient data
• Mefloquine (treatment dose)• Artemisinins (1st)• Amodiaquine• Azithromycin• Lumefantrine (component of
coartem/Riamet)• Combination therapy
– Artemisinin derivative with other drugs
– Lapdap (chlorproguanil-dapsone)
– Atovaquone-proguanil (Malarone)
– Amodiaquine-SP
Anti-malarials contra-indicated in pregnancy
• Tetracycline• Doxycycline• Halofantrine• Primaquine• Tafenoquine• Note: if serious illness, and where limited
number of drugs are available, it is necessary to balance the risk of maternal death with the hypothetical risks to the infant
Drugs that should not be used during pregnancy
• Tetracycline– Cause abnormalities of skeletal and muscular growth,
tooth development, lens/cornea• Doxycycline
– Risk of cosmetic staining of primary teeth is undetermined
– Excreted into breast milk• Primaquine
– Harmful to newborns who are relatively Glucose-6-Phosphatase-Dehydrogenase (G6PD) deficient
• Halofantrine– No conclusive studies in pregnant women– Has been shown to cause unwanted effects, including
death of the fetus, in animals