Mefloquine is more effective than the currently recommended treatment to prevent malaria infection in pregnant women living in malaria-endemic countries in sub-Saharan Africa. However, the high percentage of adverse reactions represents a barrier to its use, according to a systematic review and meta-analysis carried out by Global Health Institute Barcelona (ISGlobal). The scientists now intend to evaluate other alternative drugs that could offer the same antimalarial effect and fewer side effects.
Pregnant women are particularly vulnerable to malaria infection, which can have serious consequences for their health and their babies. For this reason, women living in malaria-endemic areas are recommended to take preventive measures against infection, including antimalarial treatment.
Currently sulfadoxine-pyrimethamine (SP) is used for this purpose, but drug-resistant parasites have begun to emerge. In addition, in HIV-infected women who take the prophylactic antibiotic cotrimoxazole, SP is not recommended because of possible drug interactions. Therefore, it is urgent to find alternative medicines, such as mefloquine, to prevent malaria in pregnant women.
The ISGlobal team has conducted a systematic literature review to determine whether the mefloquine antimalarial is safe and effective in preventing malaria in pregnant women, whether they are seronegative or seropositive for HIV. The scientists identified five studies in sub-Saharan Africa and one in Thailand (more than 8,000 women in total) that compared mefloquine with currently recommended drugs to prevent malaria in pregnant women.
The results of the studies show that, compared to SP or co-trimoxazole alone, mefloquine is more effective in reducing the level of parasites in the mother’s blood and anemia at the time of delivery. However, the medication is less tolerated (there is an increased risk of side effects that include vomiting, fatigue and dizziness). The work has been published in the Cochrane Database of Systematic Reviews.
“The conclusions agree with a review previously published by our group,” explains Raquel González, first author of the study. “The efficacy of mefloquine is well demonstrated; however, its low tolerability is a great disadvantage for its large-scale use in these populations especially vulnerable to infection, and now it is about evaluating other alternative drugs that have the same antimalarial result and fewer side effects,” adds the ISGlobal researcher.