Antimalarial(s) to be avoided in pregnancy:a) Chloroquineb) Quininec) Primaquined) Anti-folatese) Tetracyclines

Malaria is life threatening in pregnancy, therefore benefits of treatment outweigh the potential risk of antimalarials. The commonly used antimalarials are not contraindicated in pregnancy. Chloroquine is the drug of choice for treatment and prophylaxis (even in pregnancy) of all varieties of malaria. Harrison 17/e, p 1293, Williams Obs. 24/e, p 1257 According to Williams 24/e cloroquine should be used throughout pregnancy and primaquine should be used during postpartum period for malaria in pregnant moment. In cloroquine resistant P. vivax malaria-mefloquine is the DOC. In cloroquine resistant P. falciparum malaria-mefloquine or quinine is the drug of choice. Chemoprophylaxis: Pregnant women in endemic areas are candidates for chemoprophylaxis. It is also recommended for travel to endemic areas. Chloroquine is the drug of choice for prophylaxis in pregnancy. Mefloquine is the only drug adviced for pregnant women who travel to areas with drug resistant malaria. This drug is generally considered safe in 2nd and 3rd trimester of pregnancy and the limited data on 1st trimester exposure are reassuring. Harrison 17/e, p 1293 “Proguanil is considered safe for antimalarial prophylaxis in pregnancy.” Harrison 17/e, p 1293 Antimalarials contraindicated in pregnancy: “Tetracycline and doxycycline cannot be given to pregnant women”. Harrison 17/e, p 1291, 1289 “Primaquine should not be given to pregnant women and neonates. Harrison 17/e, p 1293 “Primaquine and doxycycline are contraindicated in pregnancy”. Williams 24/e, p 1257