Pregnancy Complications, Parasitic

Publication Title: 
British Journal of Clinical Pharmacology

Unlike human immunodeficiency virus (HIV) disease or tuberculosis, both of which are also major threats to public health throughout the tropics, uncomplicated falciparum malaria is relatively cheaply and rapidly cured, usually in Outpatients. However, in common with both HIV and TB (but to varying degrees), control of malaria is threatened by inadequate resources and drug resistance. Worldwide, it is Africa that carries the greatest burden of falciparum malaria mortality and morbidity; by no coincidence, it is also Africa that is most resource-limited.

Author(s): 
Winstanley, Peter
Publication Title: 
The Journal of Clinical Investigation

Malaria, the most prevalent and most pernicious parasitic disease of humans, is estimated to kill between one and two million people, mainly children, each year. Resistance has emerged to all classes of antimalarial drugs except the artemisinins and is responsible for a recent increase in malaria-related mortality, particularly in Africa. The de novo emergence of resistance can be prevented by the use of antimalarial drug combinations. Artemisinin-derivative combinations are particularly effective, since they act rapidly and are well tolerated and highly effective.

Author(s): 
White, Nicholas J.
Publication Title: 
The Journal of Infectious Diseases

BACKGROUND: There is no safe, practical, and effective treatment for pregnant women infected with multidrug-resistant Plasmodium falciparum. METHODS: We recruited pregnant Karen women in the second or third trimesters of pregnancy who had uncomplicated falciparum malaria for a randomized, open-label trial with a restricted sequential trial design of 7 days of supervised quinine (SQ7) versus 3 days of artesunate-atovaquone-proguanil (AAP). RESULTS: Eight-one pregnant women entered the study between December 2001 and July 2003; 42 were treated with SQ7 and 39 were treated with AAP.

Author(s): 
McGready, Rose
Ashley, Elizabeth A.
Moo, Eh
Cho, Thein
Barends, Marion
Hutagalung, Robert
Looareesuwan, Sornchai
White, Nicholas J.
Nosten, François
Publication Title: 
PLoS medicine

BACKGROUND: Early diagnosis and treatment with artesunate-mefloquine combination therapy (MAS) have reduced the transmission of falciparum malaria dramatically and halted the progression of mefloquine resistance in camps for displaced persons along the Thai-Burmese border, an area of low and seasonal transmission of multidrug-resistant Plasmodium falciparum. We extended the same combination drug strategy to all other communities (estimated population 450,000) living in five border districts of Tak province in northwestern Thailand.

Author(s): 
Carrara, Verena Ilona
Sirilak, Supakit
Thonglairuam, Janjira
Rojanawatsirivet, Chaiporn
Proux, Stephane
Gilbos, Valery
Brockman, Al
Ashley, Elizabeth A.
McGready, Rose
Krudsood, Srivicha
Leemingsawat, Somjai
Looareesuwan, Sornchai
Singhasivanon, Pratap
White, Nicholas
Nosten, François
Publication Title: 
Malaria Journal

BACKGROUND: An increasing number of countries in sub-Saharan Africa are changing to artemisinins combination therapy (ACT) as first or second line treatment for malaria. There is an urgent need to assess the safety of these drugs in pregnant women who may be inadvertently exposed to or actively treated with ACTs. OBJECTIVES: To examine existing published evidence on the relationship between artemisinin compounds and adverse pregnancy outcomes and consider the published evidence with regard to the safety of these compounds when administered during pregnancy.

Author(s): 
Dellicour, Stephanie
Hall, Susan
Chandramohan, Daniel
Greenwood, Brian
Publication Title: 
PloS One

OBJECTIVE: New anti-malarial regimens are urgently needed in sub-Saharan Africa because of the increase in drug resistance. We investigated the safety and efficacy of azithromycin or artesunate combined with sulfadoxine-pyrimethamine used for treatment of malaria in pregnant women in Blantyre, Malawi. METHODS/FINDINGS: This was a randomized open-label clinical trial, conducted at two rural health centers in Blantyre district, Malawi.

Author(s): 
Kalilani, Linda
Mofolo, Innocent
Chaponda, Marjorie
Rogerson, Stephen J.
Alker, Alisa P.
Kwiek, Jesse J.
Meshnick, Steven R.
Publication Title: 
Journal of Infection in Developing Countries

BACKGROUND: Malaria infection during pregnancy is a major public health problem. Due to increasing resistance to Chloroquine and Sulphadoxine/Pyrimethamine, the Ugandan national policy on malaria treatment was changed in 2005 to Artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria. The policy recommends assessment of safety and efficacy of alternative drugs for treatment of uncomplicated malaria.

Author(s): 
Kaye, Daniel Kabonge
Nshemerirwe, Ruth
Mutyaba, Twaha Serunjogi
Ndeezi, Grace
Publication Title: 
The American Journal of Tropical Medicine and Hygiene

Severe malaria is a global problem, claiming at least 1 million lives annually. Few adequately powered clinical studies have been directed at improving the management of severe malaria over the years, but this situation is slowly changing. The antimalarial treatment of severe disease is being transformed by the development and deployment of the water-soluble artemisinin derivative artesunate.

Author(s): 
Day, Nicholas
Dondorp, Arjen M.
Publication Title: 
Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America

BACKGROUND: Plasmodium falciparum infection exerts a considerable burden on pregnant women, but less is known about the adverse consequences of Plasmodium vivax infection. METHODS: In Papua, Indonesia, where multiple drug resistance to both species has emerged, we conducted a cross-sectional hospital-based study to quantify the risks and consequences of maternal malaria. RESULTS: From April 2004 through December 2006, 3046 pregnant women were enrolled in the study.

Author(s): 
Poespoprodjo, Jeanne Rini
Fobia, Wendy
Kenangalem, Enny
Lampah, Daniel A.
Warikar, Noah
Seal, Andrew
McGready, Rose
Sugiarto, Paulus
Tjitra, Emiliana
Anstey, Nicholas M.
Price, Ric N.
Publication Title: 
Antimicrobial Agents and Chemotherapy

The Plasmodium falciparum dihydrofolate reductase (PfDHFR) enzyme is the target of pyrimethamine, a component of the antimalarial pyrimethamine-sulfadoxine. Resistance to this drug is associated primarily with mutations in the Pfdhfr gene. The I164L mutant allele is of particular interest, because strains possessing this mutation are highly resistant to pyrimethamine and to chlorproguanil, a component of chlorproguanil-dapsone.

Author(s): 
Ochong, Edwin
Bell, David J.
Johnson, David J.
D'Alessandro, Umberto
Mulenga, Modest
Muangnoicharoen, Sant
Van Geertruyden, Jean-Pierre
Winstanley, Peter A.
Bray, Patrick G.
Ward, Stephen A.
Owen, Andrew

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