Sulfadoxine-pyrimethamine should preferably not be given in the first trimester of pregnancy. Sulfonamides should not be given directly to neonates because of the risk of ker-nicterus, but sulfonamide treatment of a lactating woman does not pose a threat to her breastfed neonate unless there is jaundice, prematurity or G6PD deficiency. Theoretically, there might be a risk of kernicterus if sulfonamides were administered in late pregnancy, just before delivery; however, there has been no documented case of this complication. An intramuscular preparation exists and may be useful for treatment of severe malaria if quinine or artemisinin derivatives are not available or cannot be given safely. When the contra-indications to the use of this drug are respected, and when this drug combination is used as a single-dose treatment for malaria in the prescribed manner, severe reactions are rare.
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