Drugs for treating uncomplicated malaria in pregnant women

  • Review
  • Intervention

Authors


Abstract

Background

Women are more vulnerable to malaria during pregnancy, and malaria infection may have adverse consequences for the fetus. Identifying safe and effective treatments is important.

Objectives

To compare the effects of drug regimens for treating uncomplicated falciparum malaria in pregnant women.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register (February 2008), CENTRAL (The Cochrane Library 2008, Issue 1), MEDLINE (1966 to February 2008), EMBASE (1974 to February 2008), LILACS (February 2008), mRCT (February 2008), reference lists, and conference abstracts. We also contacted researchers in the field, organizations, and pharmaceutical companies.

Selection criteria

Randomized and quasi-randomized controlled trials of antimalarial drugs for treating uncomplicated malaria in pregnant women.

Data collection and analysis

Two authors assessed trial eligibility and risk of bias, and extracted data. We performed a quantitative analysis only where we could combine the data. We combined dichotomous data using the risk ratio (RR) and presented each result with a 95% confidence interval (CI).

Main results

Ten trials (1805 participants) met the inclusion criteria. Two were quasi-randomized, seven did not describe allocation concealment, and all adjusted treatment failure to exclude new infections. One trial reported fewer treatment failures at day 63 with artesunate plus mefloquine compared with quinine (RR 0.09, 95% CI 0.02 to 0.38; 106 participants). One trial reported fewer treatment failures at day 63 with artesunate plus atovaquone-proguanil compared with quinine (RR 0.14, 95% CI 0.03 to 0.57; 80 participants). One trial reported fewer treatment failures at day 28 when amodiaquine was compared with chloroquine (RR 0.20, 95% CI 0.08 to 0.46; 420 participants) and when amodiaquine plus sulfadoxine-pyrimethamine was compared with chloroquine (RR 0.02, 95% CI 0.00 to 0.26; 418 participants). Compared with sulfadoxine-pyrimethamine given alone, one trial reported fewer treatment failures at delivery (or day 40) with artesunate plus sulfadoxine-pyrimethamine (RR 0.15, 95% CI 0.04 to 0.59; 79 participants) and azithromycin plus sulfadoxine-pyrimethamine (RR 0.27, 95% CI 0.10 to 0.76; 82 participants).

Authors' conclusions

Data are scant. Some combination treatments appear to be effective at treating malaria in pregnancy; however, safety data are limited.

摘要

背景

用於治療罹患非重症瘧疾懷孕婦女之藥物

婦女在懷孕期間較易受到瘧疾之侵襲,而瘧疾之感染對於胎兒具有不良影響。找到安全及有效之治療極為重要。

目標

比較用於治療懷孕婦女非重症惡性瘧疾之藥物處方的效應。

搜尋策略

我們搜尋Cochrane Infectious Diseases Group Specialized Register (2008年2月)、 CENTRAL (Cochrane Library 2008, Issue 1)、 MEDLINE (1966年 – to2008年2月)、 EMBASE (1974年−2008年2月)、 LILACS (2008年2月)、 mRCT (2008年2月)、 參考資料清單,以及研討會摘要. 我們也與本領域研究人員、相關機構以及藥廠聯絡。

選擇標準

以抗瘧疾藥物治療懷孕婦女非重症瘧疾之隨機及半隨機對照試驗。

資料收集與分析

由2名作者評估試驗適用性及偏差風險,並摘錄數據。我們僅在可結合數據時進行量性分析。我們使用風險比(risk ratio;RR)結合二元資料,並以95%信賴區間(confidence interval;CI)呈現各項結果。

主要結論

共有10項試驗(1805名參與者)符合收錄標準。其中2項為半隨機,7項並未敘述分組隱匿性,而所有之研究皆對治療失敗進行調整以排除新的感染。其中1項試驗報告,在第63天時,相較於quinine,以artesunate加mefloquine具有較少之治療失敗病例(RR 0.09, 95% CI 0.02 to 0.38; 106名參與者)。其中1項試驗報告,在第63天時,相較於quinine,以artesunate加 atovaquoneproguanil具有較少之治療失敗病例(RR 0.14, 95% CI 0.03 to 0.57; 80名參與者)。其中1項試驗報告,在第28天時,amodiaquine相較於chloroquine (RR 0.20, 95% CI 0.08 to 0.46;420名參與者)以及amodiaquine加sulfadoxinepyrimethamine相較於chloroquine (RR 0.02, 95% CI 0.00 to 0.26; 418名參與者)皆具有較少之治療失敗病例。相較於單獨給予之sulfadoxinepyrimethamine,其中1項試驗報告,在分娩時(或第40天),artesunate加sulfadoxinepyrimethamine (RR 0.15, 95% CI 0.04 to 0.59; 79名參與者)以及azithromycin加sulfadoxinepyrimethamine (RR 0.27, 95% CI 0.10 to 0.76; 82名參與者)具有較少之治療失敗病例。

作者結論

數據十分有限。部分之組合治療似乎可有效治療懷孕時之瘧疾;然而,有關安全性之數據相當有限。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

婦女在懷孕期間較易受到瘧疾之侵襲,而瘧疾對於胎兒可能有害。治療之選擇越來越有限,因為瘧疾寄生蟲對既有之藥物日漸產生抗性,同時也有藥物是否會傷害胎兒之考量。由隨機對照試驗所能取得之證據相當有限,因此僅能評估少數之藥物以及藥物組合。

Plain language summary

Reliable research about the benefits and harms of treatments for malaria in pregnant women is scarce

Women are more vulnerable to malaria during pregnancy, and malaria may have harmful effects on the baby. Treatment options are becoming more limited because the malaria parasite is developing resistance to existing drugs and due to concerns about whether drugs may harm the baby. Evidence from randomized controlled trials is limited, with few drugs and drug combinations being evaluated.