Critical Analysis of the Literature Comparing Artemisinin-Based Combination Therapy and Quinine Treatments for Uncomplicated Malaria in Pregnancy

In areas of high P. falciparum resistance, artemisinin derivatives and quinine are recommended as effective antimalarial drugs. In four randomized clinical trials, artemisinin- and quinine-based treatments (Quinine versus Artesunate-Atovaquone-Preguanil; Quinine versus Artesunate-Mefloquine; Quinine-Clindamycin versus Artesunate, Quinine versus Artemether-Lumefantrine) were compared to determine which regimen was more effective in treating uncomplicated malaria in pregnant women. It was not possible to make this choice as artemisinin derivatives in combination were compared with quinine alone and vice versa, as the WHO recommends dual therapy for the treatment of uncomplicated malaria in pregnant women. All regimens have been shown to be effective, with good tolerability and compliance, and less side-effects for artemisinin derivatives, and poor compliance and observance, as well as greater side-effects, for quinine. Balanced comparative studies will be useful in the future to settle this question.