Dihydroartemisinin–piperaquine holds promise as an option for malaria prevention in pregnancy

Context Malaria in pregnancy has devastating consequences for mother and fetus. WHO recommends intermittent preventive treatment in pregnancy (IPTp) with treatment doses of an efficacious antimalarial during the second and third trimesters of pregnancy at predefined intervals. Sulfadoxine–pyrimethamine is currently recommended, but high-level parasite resistance threatens its efficacy. Recent trials showed that amodiaquine, mefloquine and chloroquine–azithromycin are not suitable alternatives due to poor tolerability. This trial by Kakuru et al evaluated the artemisinin-based combination therapy (ACT), dihydroartemisinin– piperaquine, for IPTp. Dihydroartemisinin–piperaquine is already recommended by WHO for treatment of malaria in the second and third trimesters. A recent comparison of four ACTs for treatment of malaria in pregnancy in Africa showed that dihydroartemisinin–piperaquine had the best efficacy and a long post-treatment prophylactic effect, which supports its suitability for IPTp in high transmission areas.