Several antimalarials can cause significant prolongation of the electrocardiograph QT interval, which can be associated with an increased risk of potentially lethal ventricular arrhythmias. High doses of artemether and artemotil have been associated with QT prolongation in dogs, raising the possibility of a class effect with the artemisinin derivatives. Serial electrocardiograms were recorded, and QTc interval was calculated before and after administration of artesunate by intravenous injection in patients with severe falciparum malaria in Bangladesh. Of 21 adult patients with severe malaria enrolled, 8 (38%) died. The mean QTc interval was unaffected by bolus intravenous artesunate (2.4 mg/kg). In two patients, the QTc interval exceeded 0.5 seconds, but in both cases, an alternative explanation was plausible. No effect was observed on the JTc or PR interval, QRS width, blood pressure, or heart rate. Intravenous artesunate does not have significant cardiovascular effects in patients with severe falciparum malaria.

In the high malaria-transmission settings of sub-Saharan Africa, malaria in pregnancy is an important cause of maternal, perinatal and neonatal morbidity. Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) reduces the incidence of low birth-weight, pre-term delivery, intrauterine growth-retardation and maternal anaemia. However, the public health benefits of IPTp are declining due to SP resistance. The combination of azithromycin and chloroquine is a potential alternative to SP for IPTp. The combination has demonstrated synergism in vivo against P. falciparum in India. Preliminary results of studies in non-pregnant adults in sub-Saharan Africa have shown that azithromycin-chloroquine is not inferior to mefloquine, a compound currently under consideration for IPTp. The azithromycin-chloroquine combination may be safely administered at any time in pregnancy. The secondary benefits of the combination, clearing of symptomatic and asymptomatic STIs, may be as important to maternal, foetal and neonatal health as the clearance and prevention of malaria. Innovative pricing mechanisms would be required to introduce azithromycin-chloroquine for IPTp since the drug cost per pregnancy would otherwise be US $14.00 to $21.00 for two or three courses. Close monitoring of antibiotic resistance markers would need to be an essential part of any IPTp programme using azithromycin-chloroquine.