Mefloquine May Be Effective in Preventing Malaria in Pregnant Women

Highlights:

Pregnant women who live in moderate to severe malarial transmission area are at the high risk of getting affected by malaria.
Resistance to the parasite and drug interactions of Sulfadoxine-pyrimethamine with cotrimoxazole in HIV-infected women are increasing steadily.
Mefloquine has been found to be safe and effective in pregnant women than other anti-malarial drugs and also associated with a lower risk of maternal anemia.

Malaria is a mosquito-borne disease caused by the Plasmodium type of protozoans which affects humans and animals. Five different species of Plasmodium are responsible for causing an infection in human. An infected female Anopheles mosquito is responsible for transmitting the infection. Species of Plasmodium falciparum is responsible for causing most number of deaths when compared to other Plasmodium species as they cause a mild form of malaria.

Malaria - Causes, Symptoms, Diagnosis, Prevention, Treatment
Malaria is caused by a parasite that enters blood through the bite of an infected mosquito. It is characterized by fever, vomiting, shivering, sweating and other symptoms.

‘Five studies conducted in sub-Saharan Africa and one study in Thailand compared the effects of mefloquine with standard anti-malarial drugs and it was found that it can prevent malaria in both HIV-infected and HIV-uninfected pregnant women.’

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Mefloquine Use In Pregnant Women To Prevent Malaria

Malaria in pregnant women is considered to be a major public health problem as it affects both the mother and the fetus or the newborn child. The complications of malaria may vary according to the intensity of transmission rate in a particular geographical area and the individual’s level of immunity. People with high immunity levels living in a high-transmission setting may show no symptoms of P. Falciparum in pregnancy.

The effects of mefloquine to prevent malaria in pregnant women were studied in both HIV infected and uninfected women. Five studies in sub-Saharan Africa and one study in Thailand were conducted between 1987 and 2013. These studies compared the effects of mefloquine with sulfadoxine-pyrimethamine in HIV uninfected women and mefloquine with co-trimoxazole prophylaxis in HIV infected women.

The endpoints of the study showed that mefloquine was found to be more efficacious than the current standard treatments. Mefloquine helps in reducing the presence of malarial parasites in pregnant women (HIV infected and uninfected) and the occurrence of anemia during delivery. However, mefloquine does not reduce the maternal adverse effects such as abortion, stillbirth, low birth weight or premature infant and there is an increase in drug-related adverse effects such as dizziness and vomiting.

The adverse outcomes of mefloquine are considered to be the main barrier in using the drug, but due to its effectiveness, mefloquine can be used as chemoprevention against malaria throughout the pregnancy period. The World Health Organization also recommends the need of intermittent preventive therapy in pregnant women living in moderate to high risk for malaria transmission with a focus to decrease the disease risk from causing harm to the mother and fetus.

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What are the symptoms and signs of malaria?

Paroxysm (Cycle of sudden coldness and shivering followed by fever and sweating)
Fever
Joint pain
Shivering
Headache
Vomiting
Jaundice
Hemolytic anemia
Presence of blood in urine
Eye damage
Convulsions

What steps can be taken to prevent malaria?

Avoid mosquito bites by using the following measures:

Use mosquito nets
Apply insect repellent while going outdoor
Wear long and loose fitting trousers and shirts with long sleeves
Use insect repellent after applying sunscreen while under sunlight

Seek medical advice immediately if you experience any symptoms
Consult your physician before traveling to malaria transmission area
Take the malaria prevention tablets with correct dose and at the right time
Using indoor residual spraying of DDT on the walls of the home
Covering water tanks and spraying insecticides on stagnant water reduces the chances for breeding by the parasite
Implementing intermittent preventive therapy to control the spread of malaria in pregnant women
Involving community participation and promoting awareness of the disease

References:

Mefloquine for preventing malaria in pregnant women - (http://www.cochrane.org/CD011444/INFECTN_mefloquine-preventing-malaria-pregnant-women)
Mefloquine - (http://www.medicinesinpregnancy.org/Medicine--pregnancy/Mefloquine/)
Malaria in pregnant women - (http://www.who.int/malaria/areas/high_risk_groups/pregnancy/en/)

Source-Medindia

Malaria - Protection Strategies
Malaria is a dangerous disease with lethal consequences that requires protective measures for prevention and control of malaria in endemic regions of the world.