Malaria — SCE Infectious Diseases MCQ

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ModerateTropical & Imported InfectionsMalariaSCE Infectious Diseases

A 40-year-old Nigerian woman presents at 8 weeks gestation with P. falciparum malaria (parasitaemia 1.5%, no severity features). She is haemodynamically stable. Which antimalarial is contraindicated in the first trimester?

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Correct answer: C — Artesunate and all artemisinin derivatives

Artemisinin derivatives (Artesunate, Artemether, Dihydroartemisinin) are associated with embryotoxicity in animal studies and are generally avoided in the first trimester of pregnancy for uncomplicated malaria. Quinine plus Clindamycin is the recommended treatment for uncomplicated P. falciparum malaria in the first trimester. However, for severe malaria at any gestational age, IV Artesunate should still be used as the benefit outweighs the risk. In the second and third trimesters, ACTs are safe and recommended.

Reference: WHO 2022 – Malaria in pregnancy guidelines; UKHSA/UKMEAG 2016 – UK malaria treatment guidelines