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CDC recommends Coartem for pregnant women with malaria
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The CDC has recommended Coartem as an additional treatment option for pregnant women with uncomplicated malaria in the United States.
In updated guidance published in MMWR, the CDC said Coartem (artemether-lumefantrine, Novartis; AL) should be included as a treatment option for uncomplicated malaria during the second and third trimesters of pregnancy, and during the first trimester of pregnancy when other treatment options are unavailable.
AL is an artemisinin-based combination therapy, or ACT. ACTs have been endorsed by WHO for the treatment of uncomplicated malaria during the second and third trimesters and are under review as an option for women in the first trimester. AL was approved by the FDA in 2009 to treat uncomplicated malaria but had remained unapproved for use in pregnant women based on insufficient human data and animal research showing that it was potentially associated with poor pregnancy outcomes, the CDC said.
The new CDC guidance was based on a review of English-language research articles — including clinical trials, observational studies, meta-analyses and case reports — showing that AL was safe and effective in pregnant women diagnosed with uncomplicated malaria.
According to the CDC, around 1,700 cases of imported malaria are reported in the U.S. each year, including a few dozen among pregnant women.
“Malaria infection during pregnancy is associated with an increased risk for maternal and fetal complications,” researchers wrote in MMWR. “In the United States, treatment options for uncomplicated, chloroquine-resistant Plasmodium falciparum and P. vivax malaria in pregnant women are limited to mefloquine or quinine plus clindamycin. However, limited availability of quinine and increasing resistance to mefloquine restrict these options. Strong evidence now demonstrates that [AL] is effective and safe in the treatment of malaria in pregnancy.”
According to the new guidelines, AL should be considered for pregnant women with uncomplicated malaria in the second and third trimesters at the same doses recommended for nonpregnant women. Patients in the first trimester should be treated with either mefloquine or quinine plus clindamycin unless neither option is available, at which time AL should be considered, the guidance says. – by Gerard Gallagher
References:
Ballard SB, et al. MMWR Morb Mortal Wkly Rep. 2018;doi:10.15585/mmwr/mm6714a4.
CDC. Guidelines for treatment of malaria in the United States. 2013. https://www.cdc.gov/malaria/resources/pdf/treatmenttable.pdf. Accessed April 12, 2018.
Disclosures: The authors report no relevant financial disclosures.