Treatment of Malaria Parasitaemia in Infants and their Mothers

Author

via San Andrea 32, 56127 Pisa, Italy.

Abstract

Malaria is an infection sustained by three parasites namely: Plasmodium falciparum, Plasmodium vivax, and Plasmodium ovale. Plasmodium falciparum is the most common and virulent parasite. These parasites are present in different areas of the sub-Saharan African countries and Asia. In 2010, there were an estimated 219 million cases of malaria resulting in 660,000 deaths and, approximately, two-thirds were children. In sub-Saharan African countries, maternal malaria is associated with up to 200,000 estimated infant deaths yearly. Chloroquine was the world's widely used antimalarial drug, but Plasmodium falciparum is now increasingly resistant. However, Plasmodium ovale and Plasmodium vivax are sensitive to chloroquine. Pregnancy makes women vulnerable to malarial parasites and the risks of anemia, miscarriage, stillbirth and prematurity increase. Resistance to chloroquine is a major concern for treatment of malaria and alternative drugs are needed. Proguanil is safe, being very rarely associated with severe adverse reactions. Chloroquine, mefloquine, sulfadoxine-pyrimethamine, and amodiaquine have been found to be active against Plasmodium falciparum in-vitro. In the Cameroons, chloroquine was initially replaced by amodiaquine and artemisinin-lumefantrine was gradually introduced in 2004. Tanzania replaced chloroquine with sulphadoxine-pyrimethamine, and in 2006 artemisinin was introduced in the therapy. Pyrimethamine-sulfadoxine should be reserved as a second-line-treatment. Mefloquine may provoke severe neuropsychiatric reactions. In the treatment of Plasmodium malaria, which has a high mortality rate if untreated, a greater risk of adverse reactions to malarial drugs is acceptable. The aim of the present study is to review the published data on the treatment of malaria in infants and their mothers.

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