Management of Uncomplicated Malaria in Pregnancy (MIP)

In high-transmission areas (moderate to high immunity), malaria in pregnancy is often asymptomatic or associated with mild, non-specific symptoms (see section 5.1 above).

Pharmacological Treatment

Artemether/Lumefantrine (ALu) is the recommended treatment of choice for confirmed uncomplicated malaria in pregnant women in all trimesters.

First-line treatment (Uncomplicated malaria)

Artemether + Lumefantrine (ALu) (FDC) PO 20 mg + 120 mg

Common formulations

• Fixed combination: Artemether 20 mg + Lumefantrine 120 mg (6, 12, 18, 24 tablets blister packs)

• Fixed combination: Artemether 80 mg + Lumefantrine 480 mg (6 tablets blister pack)

• Dispersible pediatric tablets: Artemether 20 mg + Lumefantrine 120 mg

Table 1. Dosage regimen for ALu (artemether 20mg/lumefantrine 120mg)

Table 2: The recommended dosing schedule for ALu strength 80/480 mg

For practical purposes, a simpler dosage regimen is recommended in order to improve compliance: the first dose should be given as DOT; the second dose should strictly be given after 8 hours; subsequent doses could be given 12hourly in the second and third day of treatment until completion of 6 doses

The alternative medicines for the treatment of uncomplicated malaria, where there is no response to Artemether-Lumefantrine or it is contraindicated, is Dihydroartemisinin-Piperaquine. dihydroartemisinin+piperaquine (FDC) (PO).

Adult formulation containing 40 mg Dihydroartemisinin + 320 mg Piperaquine. Paediatrics formulation contains a fixed combination of 20 mg of Dihydroartemisinin +160 mg Piperaquine.

Table 3: Dose schedule for Dihydroartemisinin + Piperaquine

Management of fever

Patients with high fever (38.5⁰C and above) should be given an anti-pyretic medicine like paracetamol or acetylsalicylic acid every 4 to 6 hours (maximum 4 doses in 24 hours) until symptoms resolve, usually after two days.