Managing Complications in Pregnancy and Childbirth: - IAWG

S-106 Fever during pregnancy and labour• In areas of emerging mefloquine resistance, give mefloquine 15mg/kg body weight by mouth followed by 10 mg/kg body weight24 hours later.AREA OF MULTIDRUG-RESISTANT P. FALCIPARUM MALARIAMultidrug resistant P. falciparum malaria (resistant to chloroquine andsulfadoxine/pyrimethamine and quinine or mefloquine) is present incertain areas limiting treatment options. Consult the national treatmentguidelines. Treatment options include:• quinine salt (dihydrochloride or sulfate) 10 mg/kg body weight bymouth three times daily for 7 days;• OR quinine salt 10 mg/kg body weight by mouth 3 times daily for 7days PLUS clindamycin 300 mg 4 times daily for 5 days;Note: The quinine/clindamycin combination can be used in areas ofquinine resistance.• OR artesunate 4 mg/kg bodyweight by mouth in a divided loadingdose on day 1, followed by 2 mg/kg bodyweight by mouth oncedaily for 6 days.Note: Artesunate can be used in the second and third trimester fortreating uncomplicated malaria but there are insufficient data torecommend its use in the first trimester. Artesunate may be used,however, if no suitable alternative exists.VIVAX MALARIAAREA OF CHLOROQUINE-SENSITIVE P. VIVAX PARASITESChloroquine alone is the treatment of choice in areas with chloroquinesensitivevivax malaria and areas with chloroquine-sensitive vivax andfalciparum malaria. Where there is chloroquine-resistant P. falciparum,manage as a mixed infection (page S-106).• Give chloroquine base 10 mg/kg body weight by mouth once dailyfor 2 days followed by 5 mg/kg body weight by mouth on day 3.AREA OF CHLOROQUINE-RESISTANT P. VIVAX PARASITESChloroquine-resistant P. vivax has been reported in several countriesand there are limited data available to determine the optimal treatment.Before considering second line drugs for treatment failure withchloroquine, clinicians should exclude poor patient compliance and anew infection with P. falciparum. If diagnostic testing is not available,