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Meta-Analysis
. 2008 Oct 8;2008(4):CD004912.
doi: 10.1002/14651858.CD004912.pub3.

Drugs for treating uncomplicated malaria in pregnant women

Lois C Orton  1 , Aika A A Omari
Affiliations
Meta-Analysis

Drugs for treating uncomplicated malaria in pregnant women

Lois C Orton et al. Cochrane Database Syst Rev. .

Abstract

Background: Women are more vulnerable to malaria during pregnancy, and malaria infection may have adverse consequences for the fetus. Identifying safe and effective treatments is important.

Objectives: To compare the effects of drug regimens for treating uncomplicated falciparum malaria in pregnant women.

Search strategy: We searched the Cochrane Infectious Diseases Group Specialized Register (February 2008), CENTRAL (The Cochrane Library 2008, Issue 1), MEDLINE (1966 to February 2008), EMBASE (1974 to February 2008), LILACS (February 2008), mRCT (February 2008), reference lists, and conference abstracts. We also contacted researchers in the field, organizations, and pharmaceutical companies.

Selection criteria: Randomized and quasi-randomized controlled trials of antimalarial drugs for treating uncomplicated malaria in pregnant women.

Data collection and analysis: Two authors assessed trial eligibility and risk of bias, and extracted data. We performed a quantitative analysis only where we could combine the data. We combined dichotomous data using the risk ratio (RR) and presented each result with a 95% confidence interval (CI).

Main results: Ten trials (1805 participants) met the inclusion criteria. Two were quasi-randomized, seven did not describe allocation concealment, and all adjusted treatment failure to exclude new infections. One trial reported fewer treatment failures at day 63 with artesunate plus mefloquine compared with quinine (RR 0.09, 95% CI 0.02 to 0.38; 106 participants). One trial reported fewer treatment failures at day 63 with artesunate plus atovaquone-proguanil compared with quinine (RR 0.14, 95% CI 0.03 to 0.57; 80 participants). One trial reported fewer treatment failures at day 28 when amodiaquine was compared with chloroquine (RR 0.20, 95% CI 0.08 to 0.46; 420 participants) and when amodiaquine plus sulfadoxine-pyrimethamine was compared with chloroquine (RR 0.02, 95% CI 0.00 to 0.26; 418 participants). Compared with sulfadoxine-pyrimethamine given alone, one trial reported fewer treatment failures at delivery (or day 40) with artesunate plus sulfadoxine-pyrimethamine (RR 0.15, 95% CI 0.04 to 0.59; 79 participants) and azithromycin plus sulfadoxine-pyrimethamine (RR 0.27, 95% CI 0.10 to 0.76; 82 participants).

Authors' conclusions: Data are scant. Some combination treatments appear to be effective at treating malaria in pregnancy; however, safety data are limited.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Artesunate plus atovaquone‐proguanil (AS+AP) vs quinine (QN): Treatment failure at day 63 (excludes new infections, detected by PCR)
2
2
Artesunate plus mefloquine (AS+MQ) vs quinine (QN): Treatment failure at day 63 (excludes new infections, detected by PCR)
3
3
Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs sulfadoxine‐pyrimethamine (SP): Treatment failure at delivery or day 40 (excludes new infections, detected by PCR)
4
4
Amodiaquine plus sulfadoxine‐pyrimethamine (AQ+SP) vs chloroquine (CQ): Treatment failure at day 28 (excludes new infections, detected by PCR)
5
5
Amodiaquine (AQ) vs chloroquine (CQ): Treatment failure at day 28 (excludes new infections, detected by PCR)
6
6
Azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP) vs sulfadoxine‐pyrimethamine (SP): Treatment failure at delivery or day 40 (excludes new infections, detected by PCR)
1.1
1.1. Analysis
Comparison 1 Artesunate plus atovaquone‐proguanil (AS+AP) vs quinine (QN), Outcome 1 Treatment failure at day 63.
1.2
1.2. Analysis
Comparison 1 Artesunate plus atovaquone‐proguanil (AS+AP) vs quinine (QN), Outcome 2 Treatment failure at day 63 (excludes new infections, detected by PCR).
1.3
1.3. Analysis
Comparison 1 Artesunate plus atovaquone‐proguanil (AS+AP) vs quinine (QN), Outcome 3 Anaemia.
1.4
1.4. Analysis
Comparison 1 Artesunate plus atovaquone‐proguanil (AS+AP) vs quinine (QN), Outcome 4 Tinnitus.
1.5
1.5. Analysis
Comparison 1 Artesunate plus atovaquone‐proguanil (AS+AP) vs quinine (QN), Outcome 5 Low birthweight.
1.6
1.6. Analysis
Comparison 1 Artesunate plus atovaquone‐proguanil (AS+AP) vs quinine (QN), Outcome 6 Mean birthweight.
1.7
1.7. Analysis
Comparison 1 Artesunate plus atovaquone‐proguanil (AS+AP) vs quinine (QN), Outcome 7 Preterm delivery.
1.8
1.8. Analysis
Comparison 1 Artesunate plus atovaquone‐proguanil (AS+AP) vs quinine (QN), Outcome 8 Gestational age.
1.9
1.9. Analysis
Comparison 1 Artesunate plus atovaquone‐proguanil (AS+AP) vs quinine (QN), Outcome 9 Intra‐uterine growth retardation.
1.10
1.10. Analysis
Comparison 1 Artesunate plus atovaquone‐proguanil (AS+AP) vs quinine (QN), Outcome 10 Congenital abnormality.
2.1
2.1. Analysis
Comparison 2 Artesunate plus mefloquine (AS+MQ) vs quinine (QN), Outcome 1 Treatment failure at day 63 (excludes new infections, detected by PCR).
2.2
2.2. Analysis
Comparison 2 Artesunate plus mefloquine (AS+MQ) vs quinine (QN), Outcome 2 Anaemia.
2.3
2.3. Analysis
Comparison 2 Artesunate plus mefloquine (AS+MQ) vs quinine (QN), Outcome 3 Nervous system adverse events.
2.4
2.4. Analysis
Comparison 2 Artesunate plus mefloquine (AS+MQ) vs quinine (QN), Outcome 4 Gastrointestinal adverse events.
2.5
2.5. Analysis
Comparison 2 Artesunate plus mefloquine (AS+MQ) vs quinine (QN), Outcome 5 Other adverse events.
2.6
2.6. Analysis
Comparison 2 Artesunate plus mefloquine (AS+MQ) vs quinine (QN), Outcome 6 Low birthweight.
2.7
2.7. Analysis
Comparison 2 Artesunate plus mefloquine (AS+MQ) vs quinine (QN), Outcome 7 Mean birthweight.
2.8
2.8. Analysis
Comparison 2 Artesunate plus mefloquine (AS+MQ) vs quinine (QN), Outcome 8 Abortion.
2.9
2.9. Analysis
Comparison 2 Artesunate plus mefloquine (AS+MQ) vs quinine (QN), Outcome 9 Neonatal jaundice.
3.1
3.1. Analysis
Comparison 3 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP), Outcome 1 Treatment failure at delivery or day 40.
3.2
3.2. Analysis
Comparison 3 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP), Outcome 2 Treatment failure at delivery or day 40 (excludes new infections, detected by PCR).
3.3
3.3. Analysis
Comparison 3 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP), Outcome 3 Maternal anaemia.
3.4
3.4. Analysis
Comparison 3 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP), Outcome 4 Low birthweight.
3.5
3.5. Analysis
Comparison 3 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP), Outcome 5 Perinatal death.
3.6
3.6. Analysis
Comparison 3 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP), Outcome 6 Neonatal death.
4.1
4.1. Analysis
Comparison 4 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 1 Treatment failure at delivery or 40 days.
4.2
4.2. Analysis
Comparison 4 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 2 Treatment failure at delivery or day 40 (excludes new infections, detected by PCR).
4.3
4.3. Analysis
Comparison 4 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 3 Maternal anaemia.
4.4
4.4. Analysis
Comparison 4 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 4 Low birthweight.
4.5
4.5. Analysis
Comparison 4 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 5 Perinatal death.
4.6
4.6. Analysis
Comparison 4 Artesunate plus sulfadoxine‐pyrimethamine (AS+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 6 Neonatal death.
5.1
5.1. Analysis
Comparison 5 Quinine plus spiramycin (QN+SPI) vs quinine (QN), Outcome 1 Mean parasite clearance time.
5.2
5.2. Analysis
Comparison 5 Quinine plus spiramycin (QN+SPI) vs quinine (QN), Outcome 2 Mean gestational age at delivery.
6.1
6.1. Analysis
Comparison 6 Artesunate (AS) vs quinine plus clindamycin (QN+CLD), Outcome 1 Treatment failure at 48 hours (excludes new infections, detected by PCR).
6.2
6.2. Analysis
Comparison 6 Artesunate (AS) vs quinine plus clindamycin (QN+CLD), Outcome 2 Mean parasite clearance time.
6.3
6.3. Analysis
Comparison 6 Artesunate (AS) vs quinine plus clindamycin (QN+CLD), Outcome 3 Anaemia at day 7.
6.4
6.4. Analysis
Comparison 6 Artesunate (AS) vs quinine plus clindamycin (QN+CLD), Outcome 4 Low birthweight.
6.5
6.5. Analysis
Comparison 6 Artesunate (AS) vs quinine plus clindamycin (QN+CLD), Outcome 5 Mean birthweight.
6.6
6.6. Analysis
Comparison 6 Artesunate (AS) vs quinine plus clindamycin (QN+CLD), Outcome 6 Mean gestational age at delivery.
7.1
7.1. Analysis
Comparison 7 Artemether plus mefloquine (ATM+MQ) vs artemether (ATM), Outcome 1 Mean fever clearance time.
7.2
7.2. Analysis
Comparison 7 Artemether plus mefloquine (ATM+MQ) vs artemether (ATM), Outcome 2 Mean parasite clearance time.
7.3
7.3. Analysis
Comparison 7 Artemether plus mefloquine (ATM+MQ) vs artemether (ATM), Outcome 3 Adverse events.
7.4
7.4. Analysis
Comparison 7 Artemether plus mefloquine (ATM+MQ) vs artemether (ATM), Outcome 4 Mean birthweight.
8.1
8.1. Analysis
Comparison 8 Amodiaquine plus sulfadoxine‐pyrimethamine (AQ+SP) vs chloroquine (CQ), Outcome 1 Treatment failure at day 28.
8.2
8.2. Analysis
Comparison 8 Amodiaquine plus sulfadoxine‐pyrimethamine (AQ+SP) vs chloroquine (CQ), Outcome 2 Treatment failure at day 28 (excludes new infections, detected by PCR).
8.3
8.3. Analysis
Comparison 8 Amodiaquine plus sulfadoxine‐pyrimethamine (AQ+SP) vs chloroquine (CQ), Outcome 3 Adverse events.
8.4
8.4. Analysis
Comparison 8 Amodiaquine plus sulfadoxine‐pyrimethamine (AQ+SP) vs chloroquine (CQ), Outcome 4 Low birthweight.
8.5
8.5. Analysis
Comparison 8 Amodiaquine plus sulfadoxine‐pyrimethamine (AQ+SP) vs chloroquine (CQ), Outcome 5 Preterm delivery.
9.1
9.1. Analysis
Comparison 9 Amodiaquine (AQ) vs chloroquine (CQ), Outcome 1 Treatment failure at day 28.
9.2
9.2. Analysis
Comparison 9 Amodiaquine (AQ) vs chloroquine (CQ), Outcome 2 Treatment failure at day 28 (excludes new infections, detected by PCR).
9.3
9.3. Analysis
Comparison 9 Amodiaquine (AQ) vs chloroquine (CQ), Outcome 3 Adverse events.
9.4
9.4. Analysis
Comparison 9 Amodiaquine (AQ) vs chloroquine (CQ), Outcome 4 Low birthweight.
9.5
9.5. Analysis
Comparison 9 Amodiaquine (AQ) vs chloroquine (CQ), Outcome 5 Preterm delivery.
10.1
10.1. Analysis
Comparison 10 Azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 1 Treatment failure at delivery or day 40.
10.2
10.2. Analysis
Comparison 10 Azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 2 Treatment failure at delivery or day 40 (excludes new infections, detected by PCR).
10.3
10.3. Analysis
Comparison 10 Azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 3 Maternal anaemia.
10.4
10.4. Analysis
Comparison 10 Azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 4 Low birthweight.
10.5
10.5. Analysis
Comparison 10 Azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 5 Perinatal death.
10.6
10.6. Analysis
Comparison 10 Azithromycin plus sulfadoxine‐pyrimethamine (AZM+SP) vs sulfadoxine‐pyrimethamine (SP), Outcome 6 Neonatal death.
11.1
11.1. Analysis
Comparison 11 Sulfadoxine‐pyrimethamine (SP) vs chloroquine (CQ), Outcome 1 Treatment failure at day 14.
11.2
11.2. Analysis
Comparison 11 Sulfadoxine‐pyrimethamine (SP) vs chloroquine (CQ), Outcome 2 Treatment failure at day 28.
11.3
11.3. Analysis
Comparison 11 Sulfadoxine‐pyrimethamine (SP) vs chloroquine (CQ), Outcome 3 Treatment failure at day 28 (excludes new infections, detected by PCR).
11.4
11.4. Analysis
Comparison 11 Sulfadoxine‐pyrimethamine (SP) vs chloroquine (CQ), Outcome 4 Adverse events.
11.5
11.5. Analysis
Comparison 11 Sulfadoxine‐pyrimethamine (SP) vs chloroquine (CQ), Outcome 5 Low birthweight.
11.6
11.6. Analysis
Comparison 11 Sulfadoxine‐pyrimethamine (SP) vs chloroquine (CQ), Outcome 6 Preterm delivery.
12.1
12.1. Analysis
Comparison 12 Chloroquine plus clindamycin (CQ+CLD) for 3 or 5 days vs chloroquine (CQ), Outcome 1 Treatment failure at day 14.
12.2
12.2. Analysis
Comparison 12 Chloroquine plus clindamycin (CQ+CLD) for 3 or 5 days vs chloroquine (CQ), Outcome 2 Adverse event: itching.
12.3
12.3. Analysis
Comparison 12 Chloroquine plus clindamycin (CQ+CLD) for 3 or 5 days vs chloroquine (CQ), Outcome 3 Adverse event: diarrhoea.
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