Which of the following agent is safest for treating chloroquine resistant malaria in a 26 year old primigravida?
Chloroquine is the treatment of choice for malaria caused by all sensitive Plasmodium species. For the woman with chloroquine-resistant infection, which constitutes the majority of falciparum infections, quinine plus clindamycin is currently recommended. quinine may induce hyperinsulinemia and thus, possible maternal and fetal hypoglycemia. Mefloquine or atovaquone-proguanil are not currently recommended for treatment during pregnancy, although mefloquine is still recommended for chemoprophylaxis. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 58. Infectious Diseases. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
Mefloquine
Pyrimethamine
Proguanil
Quinine plus clindamycin