Sensitivity of Plasmodium falciparum to reduced dose of mefloquine in pregnant women in Nigeria

Okoyeh, Jude Nnaemeka; Lege-Oguntoye, L.; Emembolu, J.O.; Sarki, U

doi:10.1016/0001-706x(95)00125-x

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…That same study also found that women in the MQ group had significantly fewer LBW infants than women treated with CQ-containing regimens (Steketee et al 1996b). Although there is evidence that pregnant women need larger doses of MQ to achieve comparable blood levels (Na Bangchang et al 1994), there is also evidence that pregnant women living in areas with little or no MQ resistance can clear P. falciparum parasitaemia with a single reduced dose (12.5 mg/kg) of MQ (Okoyeh et al 1996).…”

Section: Efficacymentioning

confidence: 84%

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Safety, efficacy and determinants of effectiveness of antimalarial drugs during pregnancy: implications for prevention programmes in Plasmodium falciparum‐endemic sub‐Saharan Africa

Newman

Parise

Slutsker

et al. 2003

Tropical Med Int Health

104

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SummaryPlasmodium falciparum malaria in pregnancy poses substantial risk to a pregnant woman and her neonate through anaemia and low birth weight (LBW), respectively, and is responsible for up to 35% of preventable LBW in malaria-endemic areas. Chemoprophylaxis or intermittent preventive treatment (IPT) with an effective antimalarial can ameliorate the adverse effects of malaria during pregnancy. Current guidelines from the WHO recommend that women in highly malarious areas receive IPT with an effective antimalarial. Two central considerations in evaluating drugs for use during pregnancy are safety for the mother and her foetus and effectiveness, which is determined by efficacy, cost, availability, deliverability and acceptability of the drug. These factors may be scored and potential drugs or drug combinations ranked in order of potential effectiveness for use in prevention programmes. The seven most promising regimens are all IPT, primarily because they are more easily delivered and less expensive than chemoprophylaxis. Currently, IPT with sulphadoxine-pyrimethamine (SP) is more likely to have the best overall effectiveness in preventing adverse outcomes associated with malaria in pregnancy. Its low cost, wide availability, easy deliverability and acceptability make it the clear choice in countries where efficacy of the drug remains good. For countries where resistance to SP is rising or already high, amodiaquine (alone or in combination with SP or artesunate) artesunate + SP, chlorproguanil-dapsone (with and without artesunate) and artemether-lumefantrine require urgent evaluation for use in pregnancy.

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Section: Efficacymentioning

confidence: 84%

“…Although there is evidence that pregnant women need larger doses of MQ to achieve comparable blood levels (Na Bangchang et al. 1994), there is also evidence that pregnant women living in areas with little or no MQ resistance can clear P. falciparum parasitaemia with a single reduced dose (12.5 mg/kg) of MQ (Okoyeh et al. 1996).…”

Section: Efficacymentioning

confidence: 99%

Safety, efficacy and determinants of effectiveness of antimalarial drugs during pregnancy: implications for prevention programmes in Plasmodium falciparum‐endemic sub‐Saharan Africa

Newman

Parise

Slutsker

et al. 2003

Tropical Med Int Health

104

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“…121 Curiously, chloroquine was reported to be 100% effective against falciparum malaria in a study in northern Nigeria in 1993. 122 In Malawi, Heymann et al 123 found that 37% of pregnant women failed to eliminate P. falciparum after 4 weeks of supervised chemoprophylaxis with chloroquine. In 1990, 37.1% of women in the Central African Republic had placental P. falciparum malaria, despite chemoprophylaxis.…”

Section: Introductionmentioning

confidence: 99%

A brief review on features of falciparum malaria during pregnancy

Manirakiza

Serdouma

Ngbale

et al. 2017

J Public Health Afr

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Malaria in pregnancy is a serious public health problem in tropical areas. Frequently, the placenta is infected by accumulation of Plasmodium falciparum-infected erythrocytes in the intervillous space. Falciparum malaria acts during pregnancy by a range of mechanisms, and chronic or repeated infection and co-infections have insidious effects. The susceptibility of pregnant women to malaria is due to both immunological and humoral changes. Until a malaria vaccine becomes available, the deleterious effects of malaria in pregnancy can be avoided by protection against infection and prompt treatment with safe, effective antimalarial agents; however, concurrent infections such as with HIV and helminths during pregnancy are jeopardizing malaria control in sub-Saharan Africa.

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“…Similarly, Okoye and others reported good effectiveness and tolerability of a reduced dose of mefloquine in pregnant women. 19 Although MSP appears to be a good substitute for chloroquine in an area with CQ-resistant P. falciparum, its affordability by the low socioeconomic rural population (75% of Nigerians) is a cause for concern. Further studies are required to compare the cost and benefits of MSP against the risk of recurrent malaria due to the drug-resistant P. falciparum (RII-RIII) and the development of resistance to sulfadoxine/pyrimethamine.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and tolerability of a low-dose mefloquine-sulfadoxine-pyrimethamine combination compared with chloroquine in the treatment of acute malaria infection in a population with multiple drug-resistant Plasmodium falciparum.

Ezedinachi¹,

Ekanem²,

Chukwuani³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. The efficacy and tolerability of single, low-dose mefloquine, sulfadoxine-pyrimethamine (MSP) combination was compared with chloroquine (CQ) for malaria treatment in a malaria-endemic area of Nigeria with multiple drug-resistant Plasmodium falciparum. The two drug regimens (MSP and CQ) were tested in a 12-month prospective population study. The patients were divided into two groups. Group 1 patients were treated presumptively, based on malaria symptoms. Group 2 patients were treated based on a parasitologic diagnosis using the World Health Organization seven-day in vivo test and extended to a 28-day follow-up period. Tolerability was assessed by the incidence and intensity of adverse events. One thousand nine hundred thirty-five patients visiting 10 health facilities, including the University of Calabar Teaching Hospital, were enrolled. The study showed that the low-dose MSP was efficacious, with day 7 response rates of 95% and 91% for (presumptive) Group 1 and (in vivo) Group 2, respectively, while CQ had day 7 response rates of 82% and 66% in Groups 1 and 2, respectively. The low-dose MSP was significantly (P Ͻ 0.0001) more efficacious, with faster fever and parasite clearance times than CQ in this area of CQ-resistant P. falciparum malaria. Eight patients treated with CQ, including seven severe cases (RII-RIII) were successfully re-treated with MSP. Adverse events were generally more common among those treated with MSP (29%) than those treated with CQ (17%). However, the adverse events caused by both drugs were mild to moderate and self-limited. The MSP combination appears to be a good substitute for CQ, in view of multiple drug resistance, especially in areas with severe (RII-RIII) malaria.

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Sensitivity of Plasmodium falciparum to reduced dose of mefloquine in pregnant women in Nigeria

Cited by 4 publications

References 9 publications

Safety, efficacy and determinants of effectiveness of antimalarial drugs during pregnancy: implications for prevention programmes in Plasmodium falciparum‐endemic sub‐Saharan Africa

Safety, efficacy and determinants of effectiveness of antimalarial drugs during pregnancy: implications for prevention programmes in Plasmodium falciparum‐endemic sub‐Saharan Africa

A brief review on features of falciparum malaria during pregnancy

Efficacy and tolerability of a low-dose mefloquine-sulfadoxine-pyrimethamine combination compared with chloroquine in the treatment of acute malaria infection in a population with multiple drug-resistant Plasmodium falciparum.

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