Abstract
BackgroundControl of malaria in pregnant women is still a major challenge as it constitutes an important cause of maternal and neonatal mortality. Mefloquine (MQ) has been used for malaria chemoprophylaxis in non-immune travellers for several decades and it constitutes a potential candidate for intermittent preventive treatment in pregnant women (IPTp).MethodsThe safety of MQ, including its safety in pregnancy, is controversial and a continuing subject of debate. Published studies which evaluated the use of MQ for malaria prevention or treatment in pregnant women and which reported data on drug tolerability and/or pregnancy outcomes have been reviewed systematically.ResultsEighteen articles fitted the inclusion criteria, only one study was double-blind and placebo controlled. No differences were found in the risk of adverse pregnancy outcomes in women exposed to MQ compared to those exposed to other anti-malarials or to the general population. MQ combined with artesunate seems to be better tolerated than standard quinine therapy for treatment of non-severe falciparum malaria, but a MQ loading dose (10 mg/kg) is associated with more dizziness compared with placebo. When used for IPTp, MQ (15 mg/kg) may have more side effects than sulphadoxine- pyrimethamine.ConclusionsIn the published literature there are no indications that MQ use during pregnancy carries an increased risk for the foetus. Ideally, the use of MQ to prevent malaria should be based on a risk-benefit analysis of adverse effects against the risk of acquiring the infection. For this purpose double-blinded randomized controlled trials in African pregnant women are much needed.
Highlights
Control of malaria in pregnant women is still a major challenge as it constitutes an important cause of maternal and neonatal mortality
Eighteen articles which met the inclusion criteria were included in the final selection: eight reported safety data of MQ when used for malaria treatment (Table 1) and ten evaluated MQ in pregnant women for malaria prevention (See Additional file 1)
The safety of mefloquine when used for the treatment of malaria in pregnancy The first reports on the use of MQ in pregnant women are from the late 1980s [36,37]
Summary
Control of malaria in pregnant women is still a major challenge as it constitutes an important cause of maternal and neonatal mortality. Mefloquine (MQ) has been used for malaria chemoprophylaxis in non-immune travellers for several decades and it constitutes a potential candidate for intermittent preventive treatment in pregnant women (IPTp). The World Health Organization (WHO) recommends a package of interventions to prevent the consequences of malaria during pregnancy in areas with stable transmission in subSaharan Africa including the use of insecticide-treated nets (ITNs), intermittent preventive treatment (IPT) with. Mefloquine (MQ) has many of the characteristics needed for an anti-malarial to replace SP for IPTp [22] These include: 1) a long half-life (median between 14 and 28 days at curative doses and between 12 and 17 days at prophylactic doses); 2) single dose administration; 3) a well-characterized pharmacokinetic profile in pregnant women [23,24,25]; 4) infrequent MQ resistance in Africa; and, 5) an acceptable reproductive toxicity profile in animal studies. The drug was recently reclassified as pregnancy category B (though initially rated as C) by the US- Food and Drug Administration (FDA) [28]
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