Treatment for Malaria during Pregnancy | CDC EID

EID Journal Home > Volume 16, Number 11–November 2010
Volume 16, Number 11–November 2010
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Sulfadoxine/Pyrimethamine Intermittent Preventive Treatment for Malaria during Pregnancy

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EID Journal Home > Volume 16, Number 11–November 2010
Volume 16, Number 11–November 2010
Synopsis
Sulfadoxine/Pyrimethamine Intermittent Preventive Treatment for Malaria during Pregnancy

Philippe Deloron, Comments to Author Gwladys Bertin, Valérie Briand, Achille Massougbodji, and Michel Cot
Author affiliations: Institut de Recherche pour le Développement, Paris, France (P. Deloron, G. Bertin, V. Briand, M. Cot); Université Paris Descartes, Paris (P. Deloron, G. Bertin, V. Briand, M. Cot); and Faculté des Sciences de la Santé, Cotonou, Benin (A. Massougbodji)

Suggested citation for this article

Abstract
For monitoring efficacy of sulfadoxine/pyrimethamine intermittent preventive treatment for malaria during pregnancy, data obtained from studies of children seemed inadequate. High prevalence of triple and quadruple mutants in the dihydropteroate synthase and dihydrofolate reductase genes of Plasmodium falciparum parasites contrasts with the efficacy of sulfadoxine/pyrimethamine in reducing low birthweights and placental infection rates. In light of this discrepancy, emphasis on using molecular markers for monitoring efficacy of intermittent preventive treatment during pregnancy appears questionable. The World Health Organization recently proposed conducting in vivo studies in pregnant women to evaluate molecular markers for detecting resistance precociously. Other possible alternative strategies are considered.

Malaria during pregnancy is a major cause of anemia and maternal death and one of the main causes of low birthweight (1,2). Consequently, the World Health Organization (WHO) recommends protection for women during pregnancy. Until recently, prevention consisted of weekly chemoprophylaxis with either chloroquine or sulfadoxine/pyrimethamine. Because of poor patient compliance with prophylaxis and increasing resistance of parasite strains to chloroquine, administration of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine/pyrimethamine is now recommended for all pregnant women living in areas with stable malaria transmission (3). Sulfadoxine/pyrimethamine is given during antenatal visits at curative doses (1,500 mg sulfadoxine and 75 mg pyrimethamine; i.e., 3× the prophylactic dosage previously used) at least twice during pregnancy, once at the second trimester and once at least 1 month after the first treatment.

IPTp with sulfadoxine/pyrimethamine has proven efficacious in reducing the incidence of pregnancy-associated malaria (4,5) and is currently part of the national malaria prevention program in most countries in Africa. However, resistance to sulfadoxine/pyrimethamine is increasing in Africa (6,7). In many countries, sulfadoxine/pyrimethamine now demonstrates inadequate therapeutic efficacy in children <5 years of age (8–10) and is no longer the drug of choice for treatment, having been replaced by artemisinin combination therapy, according to WHO guidelines. Thus, this drug will soon be compromised, and an urgent need exists to assess alternative drug regimens for IPTp. full-text: Treatment for Malaria during Pregnancy | CDC EID

Suggested Citation for this Article

Deloron P, Bertin G, Briand V, Massougbodji A, Cot M. Sulfadoxine/pyrimethamine intermittent preventive treatment for malaria during pregnancy. Emerg Infect Dis [serial on the Internet]. 2010 Nov [date cited].
http://www.cdc.gov/EID/content/16/10/1666.htm

DOI: 10.3201/eid1611.101064