Pharmacological Approach to Combat Mosquito Transmitted Malaria

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Malaria in pregnancy causes anemia, miscarriage in the first trimester, stillbirths, premature

births (birth prior to 37 weeks of gestation), and low birthweight (i.e. less than 2.5 kg). In

Africa, up to 100,000 infant mortalities per annum are due to low birthweight because

of maternal infection with P. falciparum whilst pregnant. Low birthweight is the main

cause of the diseases and deaths in neonates and early childhood and cardiac diseases late

in life [7, 10, 11, 12, 13]. In extreme transmission regions, notwithstanding the hostile

effects on fetal growth, malaria is generally asymptomatic in pregnancy or is coupled with

symptoms that are non-specific and mild. Inadequate data exists on the safety, efficacy, and

pharmacokinetics of most antimalarial drugs, especially in the first trimester.

10.2

PHARMACOLOGICAL TREATMENT OF MALARIA

The principal objective of treatment^10.1 is to necessitate the quick and complete re-

moval of the Plasmodium parasites from a patient’s circulation to prevent an uncomplicated

malaria from progressing to severe infection or mortality. Effective malaria management

also decreases transmission of the disease to other people by decreasing the disease reser-

voir and by preventing the emergence and spread of resistance to antimalarial drugs.

World health organization (WHO) recommended the use of artemisinin based com-

bination therapy (ACT) as first line treatment for uncomplicated malaria [14]. ACT is a

combination of a fast-acting artemisinin derivative with a slower acting partner drug. This

combination is based on the fact that the fast, short acting artemisinin derivative decreases

the number of parasites quickly while the slower, prolonged acting partner drug clears the

residual parasites from the blood and protects artemisinin derivatives form developing re-

sistance. Regardless of whether the patient is semi immune or not, a complete treatment

course of a greatly efficacious ACT must be administered. Effective ACT regimens must

be provided as a 72 h treatment with an artemisinin derivative. The following five ACTs on

Table (10.1)^10.2 have been recommended for use in children and adults with the exception

of pregnant women in the first trimester.

Table 10.1: The five recommended ACTs for treating uncomplicated P. falciparum malaria.

Artemisinin derivative / drug

Partner drug

Artemether

Lumefantrine

Artesunate

Amodiaquine

Artesunate

Mefloquine

Dihydroartemisinin

Piperaquine

Artesunate

Sulphadoxine – pyrimethamine

10.1Kindly note, as described in the introduction of this book, the Editor is not responsible for any suggestion

for treatments or therapies described in this chapter or other chapters. For detailed information, please get in

touch with the authors or the corresponding author directly.

10.2Adapted from WHO 2015. Guidelines for treatment of malaria 3rd Ed. [15].