The safety of artemisinins during pregnancy: a pressing question

Dellicour, Stephanie; Hall, Susan T.; Chandramohan, Daniel; Greenwood, Brian

doi:10.1186/1475-2875-6-15

Cited by 78 publications

(39 citation statements)

References 31 publications

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“…It is known that artemether-lumefantrine should be used carefully by pregnant women and in patients with cardiovascular disease 12,13. In this study, 84.6% of the drug dispensers interviewed were not aware of the contraindications for artemether-lumefantrine.…”

Section: Discussionmentioning

confidence: 76%

Knowledge among drug dispensers and antimalarial drug prescribing practices in public health facilities in Dar es Salaam

Kamuhabwa¹,

Silumbe²

2013

DHPS

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BackgroundIrrational prescribing and dispensing of antimalarials has been identified as a contributing factor in the emergence of malaria parasites resistant to existing antimalarial drugs. Factors that contribute to such irrational prescribing and dispensing should therefore be identified to address this problem. The aim of this study was to assess irrational antimalarial drug dispensing and prescribing practices in public health facilities.MethodsA descriptive-retrospective cross-sectional study was conducted between January and June 2011 in order to assess prescribing and dispensing practices for antimalarial drugs in three public hospitals and nine health centers in Dar es Salaam, Tanzania. Thirty-two drug dispensers were interviewed using a structured questionnaire. A total of 4,320 prescriptions for the period January to December 2010 were collected and assessed for antimalarial drug prescribing patterns.ResultsThe majority (84.6%) of drug dispensers had poor knowledge regarding the basic information required from patients before dispensing artemether-lumefantrine. Seventeen of 32 drug dispensers did not know the basic information that should be given to patients in order to increase absorption of artemether-lumefantrine after oral intake. Most drug dispensers also showed limited knowledge about the dosage and contraindications for artemether-lumefantrine. Eighty-seven percent of all prescriptions contained artemether-lumefantrine as the only antimalarial drug, 77.1% contained at least one analgesic, and 26.9% contained at least one antibiotic, indicating unnecessary use of analgesics and antibiotics with antimalarial drugs. A substantial number of prescriptions contained antimalarial drugs that have already been declared ineffective for the treatment of malaria in Tanzania, providing additional evidence of inadequate knowledge among health care workers concerning treatment policy.ConclusionDespite the government’s efforts to increase public awareness regarding use of artemether-lumefantrine as first-line treatment for uncomplicated malaria, there is still irrational prescribing, dispensing, and use of this combination. Based on the results of this study, it is proposed that regular on-the-job training and continuing education be provided to drug dispensers and prescribers in public health facilities.

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Section: Discussionmentioning

confidence: 76%

Knowledge among drug dispensers and antimalarial drug prescribing practices in public health facilities in Dar es Salaam

Kamuhabwa¹,

Silumbe²

2013

DHPS

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“…Pregnant women are considered a high-risk group for malaria infection, but there are currently no data on the use of dihydroartemisinin-piperaquine in pregnancy [29]. Inadvertent exposure to dihydroartemisinin-piperaquine has been documented in two women (at 11 weeks and 18 weeks gestation) who delivered normal babies [30]. A large multicentre trial investigating the safety and the efficacy of dihydroartemisinin-piperaquine and other artemisinin-based combination treatments in pregnant women with malaria in the second and third trimester will soon start in four African countries (Burkina Faso, Ghana, Malawi and Zambia) with funding from the European and Developing Countries Clinical Trials Partnership (EDCTP) and the Gates Foundation.…”

Section: Future Perspectivesmentioning

confidence: 97%

Progress in the development of piperaquine combinations for the treatment of malaria

D’Alessandro

2009

Current Opinion in Infectious Diseases

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“…In high transmission areas, pregnant women are at high risk of developing severe malaria, spontaneous abortion, stillbirth or premature delivery. Infected pregnant women are often asymptomatic but parasitaemia can cause maternal anaemia and low birth weight, a leading cause of infant morbidity and mortality (Dellicour et al, 2007). Malaria causes over 850,000 child deaths every year, mostly in Africa and Asia (Fig.…”

Section: Special High Risk Groupsmentioning

confidence: 99%