The drugs are many and the choice of the drug to use will depend on the clinical presentation, severity of the malaria infection, patient’s reaction to the drug, any underlying disease or co-morbidites and other drugs the patient was taking before the malaria attack.
It is better and safer to avoid anti-malaria drugs in the first trimester of pregnancy. If it must be used, the clinical judgment of the doctor will have to be employed to determine the most effective management to save the mother first and if possible, the foetus. However, in the second and third trimesters, sulphadoxine/pyrimethamine combination may be used. However, artemether may be used under medical supervision if the benefit to the mother outweighs the risk to the foetus. The bottom line is anti-malaria drugs are not too safe to use during pregnancy, one should speak to his/her doctor if you are pregnant or may become pregnant to decide the course of treatment that will be best for you.
Most anti-malaria drugs are secreted into the breast-milk and it is not advisable for a breast-feeding mother to take the drugs since they will surely get to the baby through the breast-milk, unless the benefits outweigh the risks.