Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy
In areas where multidrug-resistant Plasmodium falciparum (MDR-Pf) is prevalent, only quinine is known to be safe and effective in pregnant women. On the western border of Thailand, 7 days of supervised quinine (30 mg/kg daily) cures two-thirds of P. falciparum-infected women in the 2nd and 3rd trime...
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th-mahidol.265972018-09-07T16:52:45Z Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy Rose McGready Thein Cho Samuel Leopoldo Villegas Alan Brockman Michele Van Vugt Sornchai Looareesuwan Nicholas J. White François Nosten Shoklo Malaria Research Unit Mahidol University John Radcliffe Hospital University of Amsterdam Instituto de Altos Estudios en Salud Pública Immunology and Microbiology Medicine In areas where multidrug-resistant Plasmodium falciparum (MDR-Pf) is prevalent, only quinine is known to be safe and effective in pregnant women. On the western border of Thailand, 7 days of supervised quinine (30 mg/kg daily) cures two-thirds of P. falciparum-infected women in the 2nd and 3rd trimesters of pregnancy. Artesunate is effective against MDR-Pf and the limited data on its use in pregnancy suggest it is safe. An open randomized comparison of supervised quinine (10 mg salt/kg every 8 h) in combination with clindamycin (5 mg/kg every 8 h) for 7 days (QC7) versus artesunate 2 mg/kg per day for 7 days (A7) was conducted in 1997-2000 in 129 Karen women with acute uncomplicated falciparum malaria in the 2nd or 3rd trimesters of pregnancy. There was no difference in the day-42 cure rates between the QC7 (n = 65) and A7 (n = 64) regimens with an efficacy of 100% in both, confirmed by parasite genotyping. The A7 regimen was also associated with less gametocyte carriage; the average person-gametocyte-weeks for A7 was 3 (95% CI 0-19) and for QC7 was 39 (95% CI 21-66) per 1000 person-weeks, respectively (P < 0.01). There was no difference in gastrointestinal symptoms between the groups but there was significantly more tinnitus in the QC7 group compared to the A7 group (44.9% vs 8.9%; RR 5.1; 95% CI 1.9-13.5; P < 0.001). The favourable results with quinine-clindamycin mean that there is a useful back-up treatment for women with falciparum malaria who experience quinine and artesunate failures in pregnancy. Adherence to the 7-day regimen and cost (US$18.50 per treatment) are likely to be the main obstacles to this regimen. 2018-09-07T09:42:48Z 2018-09-07T09:42:48Z 2001-01-01 Article Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.95, No.6 (2001), 651-656 10.1016/S0035-9203(01)90106-3 00359203 2-s2.0-0035723811 https://repository.li.mahidol.ac.th/handle/123456789/26597 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=0035723811&origin=inward |
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Immunology and Microbiology Medicine Rose McGready Thein Cho Samuel Leopoldo Villegas Alan Brockman Michele Van Vugt Sornchai Looareesuwan Nicholas J. White François Nosten Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy |
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In areas where multidrug-resistant Plasmodium falciparum (MDR-Pf) is prevalent, only quinine is known to be safe and effective in pregnant women. On the western border of Thailand, 7 days of supervised quinine (30 mg/kg daily) cures two-thirds of P. falciparum-infected women in the 2nd and 3rd trimesters of pregnancy. Artesunate is effective against MDR-Pf and the limited data on its use in pregnancy suggest it is safe. An open randomized comparison of supervised quinine (10 mg salt/kg every 8 h) in combination with clindamycin (5 mg/kg every 8 h) for 7 days (QC7) versus artesunate 2 mg/kg per day for 7 days (A7) was conducted in 1997-2000 in 129 Karen women with acute uncomplicated falciparum malaria in the 2nd or 3rd trimesters of pregnancy. There was no difference in the day-42 cure rates between the QC7 (n = 65) and A7 (n = 64) regimens with an efficacy of 100% in both, confirmed by parasite genotyping. The A7 regimen was also associated with less gametocyte carriage; the average person-gametocyte-weeks for A7 was 3 (95% CI 0-19) and for QC7 was 39 (95% CI 21-66) per 1000 person-weeks, respectively (P < 0.01). There was no difference in gastrointestinal symptoms between the groups but there was significantly more tinnitus in the QC7 group compared to the A7 group (44.9% vs 8.9%; RR 5.1; 95% CI 1.9-13.5; P < 0.001). The favourable results with quinine-clindamycin mean that there is a useful back-up treatment for women with falciparum malaria who experience quinine and artesunate failures in pregnancy. Adherence to the 7-day regimen and cost (US$18.50 per treatment) are likely to be the main obstacles to this regimen. |
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Shoklo Malaria Research Unit |
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Shoklo Malaria Research Unit Rose McGready Thein Cho Samuel Leopoldo Villegas Alan Brockman Michele Van Vugt Sornchai Looareesuwan Nicholas J. White François Nosten |
format |
Article |
author |
Rose McGready Thein Cho Samuel Leopoldo Villegas Alan Brockman Michele Van Vugt Sornchai Looareesuwan Nicholas J. White François Nosten |
author_sort |
Rose McGready |
title |
Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy |
title_short |
Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy |
title_full |
Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy |
title_fullStr |
Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy |
title_full_unstemmed |
Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy |
title_sort |
randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy |
publishDate |
2018 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/26597 |
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1763487161662832640 |