A 38-year-old tribal woman in Odisha presents with high-grade fever, jaundice, and altered sensorium 10 days after entering a forest area for collection. Blood smear shows ring forms and banana-shaped gametocytes. She is 14 weeks pregnant. Which antimalarial regimen is MOST appropriate?
- A Artemether-Lumefantrine (AL) for 3 days
- B Artesunate IV followed by Quinine + Clindamycin ✓
- C Quinine + Clindamycin for 7 days
- D Chloroquine + Primaquine as per NVBDCP schedule
Explanation
This is severe falciparum malaria (cerebral features + jaundice) in the second trimester. WHO and NVBDCP guidelines recommend IV artesunate as the drug of choice for severe malaria regardless of trimester. After initial parenteral treatment and clinical improvement, the patient should be stepped down to Quinine + Clindamycin for 7 days, as artemisinin-based combinations are preferred only when IV artesunate is unavailable in the first trimester; in the second and third trimesters ACTs are acceptable but IV artesunate remains first-line for severe disease. Primaquine is contraindicated in pregnancy due to haemolysis risk.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.