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SULFADOXINE-PYRIMETHAMINE FOR IPTp

Sunday, 29th of April 2012

'Women who received full IPTp with SP had lower peripheral (P = .018) and placental (P < .001) parasite densities than women who received suboptimal IPTp (<2 doses).'

SULFADOXINE-PYRIMETHAMINE FOR IPTp

 

Abstract below; full text available to subscribers

       Expand+Clinical Infectious Diseasescid.oxfordjournals.org

1. Clin Infect Dis. (2012) doi: 10.1093/cid/cis301 First published online: March 22, 2012

 

Antenatal Receipt of Sulfadoxine-Pyrimethamine Does Not Exacerbate Pregnancy-Associated Malaria Despite the Expansion of Drug-Resistant Plasmodium falciparum: Clinical Outcomes From the QuEERPAM Study

1. 1.       Steve M. Taylor1,2, Alejandro L. Antonia1,Ebbie Chaluluka3,Victor Mwapasa3,4, Gaoqian Feng5,a,

  Malcolm E. Molyneux3,6,  Feiko O. ter Kuile7,8, Steven R. Meshnick1, and Stephen J. Rogerson5

 

+ Author Affiliations

1. 1.       ¹Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
2. 2.       ²Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
3. 3.       ³Malawi–Liverpool–Wellcome Trust Clinical Research Programme
4. 4.       ⁴Department of Community Health, College of Medicine, Blantyre, Malawi
5. 5.       ⁵Department of Medicine (RMH/WH), University of Melbourne, Australia
6. 6.       ⁶School of Tropical Medicine, University of Liverpool
7. 7.       ⁷Child and Reproductive Health Group, Liverpool School of Tropical Medicine, United Kingdom
8. 8.       ⁸Department of Infectious Diseases, Tropical Medicine, and AIDS, Academic Medical Center, University of Amsterdam, The Netherlands
9. Correspondence: Steve M. Taylor, MD, MPH, Department of Epidemiology, Gillings School of Global Public Health, Campus Box 7435, Chapel Hill, NC 27599 (taylo115@email.unc.edu).

Abstract

Background Antenatal intermittent preventive therapy with 2 doses of sulfadoxine-pyrimethamine (IPTp-SP) is the mainstay of efforts in sub-Saharan Africa to prevent pregnancy-associated malaria (PAM). Recent studies report that drug resistance may cause IPTp-SP to exacerbate PAM morbidity, raising fears that current policies will cause harm as resistance spreads.

Methods We conducted a serial, cross-sectional analysis of the relationships between IPTp-SP receipt, SP-resistant Plasmodium falciparum, and PAM morbidity in delivering women during a period of 9 years at a single site in Malawi. PAM morbidity was assessed by parasite densities, placental histology, and birth outcomes.

Results The prevalence of parasites with highly SP-resistant haplotypes increased from 17% to 100% (P < .001), and the proportion of women receiving full IPTp (≥2 doses) increased from 25% to 82% (P < .001). Women who received full IPTp with SP had lower peripheral (P = .018) and placental (P < .001) parasite densities than women who received suboptimal IPTp (<2 doses). This effect was not significantly modified by the presence of highly SP-resistant haplotypes. After adjustment for covariates, the receipt of SP in the presence of SP-resistant P. falciparum did not exacerbate any parasitologic, histologic, or clinical measures of PAM morbidity.

Conclusions In this longitudinal study of malaria at delivery, the receipt of SP as IPTp did not potentiate PAM morbidity despite the increasing prevalence and fixation of SP-resistant P. falciparum haplotypes. Even when there is substantial resistance, SP may be used in modified IPTp regimens as a component of comprehensive antenatal care.

       Received December 2, 2011.

       Accepted February 23, 2012.

© The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.