Malaria in pregnancy — DTM&H MCQ
Instant feedback + full explanation. One question, done properly.
Educational content. Not a substitute for clinical judgement or local policy.
Reveal the answer and explanation
Correct answer: D — Artemether-lumefantrine for 3 days
The correct answer is D, artemether-lumefantrine for 3 days. UK national guidance on the treatment of malaria specifically addresses pregnancy and states that uncomplicated falciparum malaria in the second and third trimester should be treated with artemether-lumefantrine. This woman is at 28 weeks (third trimester), has parasitaemia of 1.5% with no danger signs, so she meets the criteria for uncomplicated disease and falls in the gestational window where an ACT is preferred over quinine-based regimens because of better tolerability, faster parasite clearance and equivalent or superior efficacy without evidence of harm to the fetus at this stage. Quinine-based treatment is reserved for the first trimester, when data on artemisinin safety are more limited. Why the other options are wrong: E. Quinine plus clindamycin for 7 days: this is the first-line choice specifically for uncomplicated malaria in the first trimester, not the second or third, and it is less well tolerated (cinchonism, hypoglycaemia) with poorer adherence over its longer 7 day course. C. Sulfadoxine-pyrimethamine as a single dose: this drug is used for intermittent preventive treatment in pregnancy (IPTp) in endemic settings, not for treating an established acute clinical episode of malaria. A. Chloroquine for 3 days: P. falciparum has widespread chloroquine resistance across sub-Saharan Africa including Malawi, making this drug ineffective for treatment. B. Artesunate monotherapy for 7 days: artemisinin monotherapy is avoided in all patients, pregnant or not, because it drives resistance and does not clear the full parasite burden; artemisinins must always be combined with a partner drug as an ACT. Key point: in the second and third trimester of pregnancy, uncomplicated falciparum malaria is treated the same as in non-pregnant adults, with an ACT such as artemether-lumefantrine, whereas quinine plus clindamycin is reserved for the first trimester.
Reference: UK malaria treatment guidelines 2016 (Lalloo DG, et al., Journal of Infection 2016; endorsed by PHE/UKHSA HCID unit): Recommendation 17, uncomplicated falciparum malaria in second/third trimester of pregnancy treated with artemether-lumefantrine. https://www.journalofinfection.com/article/S0163-4453(16)00047-5/fulltext