In vivo efficacy of sulphadoxine-pyrimethamine for the treatment of asymptomatic parasitaemia in pregnant women in Machinga District, Malawi

Malaria Journal

Research

Dyson Mwandama¹  Don P Mathanga²  Ryan E Wiegand³  Ya Ping Shi³  Jacek Skarbinski³  Julie Gutman³  Nnaemeka C Iriemenam³  Joseph Abdallah⁴ 

[1] Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi;Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi;Department of Community Health, College of Medicine, Lilongwe, Malawi;Malaria Branch, Division of Parasitic Diseases & Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA;Rwanda Zambia HIV Research Group, Emory University, Atlanta, GA, USA;

关键词: Malaria;    Pregnancy;    Intermittent-preventive treatment;    Sulphadoxine-pyrimethamine;    in vivo;    Malawi;   

DOI  :  10.1186/s12936-015-0710-7

 received in 2015-01-07, accepted in 2015-04-23,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe effectiveness of sulphadoxine-pyrimethamine (SP) intermittent preventive treatment of malaria in pregnancy (IPTp) might be compromised by high prevalence of resistance-associated Plasmodium falciparum dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) mutations. As a proxy for IPTp-SP effectiveness, the in vivo efficacy of SP to clear parasitaemia and prevent reinfection in asymptomatic parasitaemic pregnant women in an area with high SP resistance prevalence was assessed.MethodsPregnant women 16–26 weeks’ gestation with asymptomatic parasitaemia presenting for antenatal care were given IPTp-SP and followed for 42 days. The primary outcome was polymerase chain reaction (PCR) uncorrected 42-day survival rate; the per cent of patients without recrudescence or reinfection by day 42. PCR was used to distinguish recrudescence from reinfection. DNA was sequenced to detect resistance-associated dhfr and dhps mutations.ResultsOf 245 pregnant women included in the intention-to-treat analysis, 93.9% cleared their parasitaemia by day 7. The day 42 PCR-uncorrected survival rate was 58.1% (95% confidence interval (CI) 51.5-65.7) and day 42 PCR-corrected survival was 68.7% (CI 61.4-76.0). Recrudescence was more common among primi- than among multigravid women; recrudescence rate 33.3% (CI 25.1-42.4%) versus 21.4% (CI 15.0-29.0%) (log rank test p-value 0.006). The quintuple mutant was present in nearly all samples (95%), while 2% were sextuple mutants with an additional mutation at dhps A581G.ConclusionsSP efficacy for acute malaria treatment has been compromised by resistance, but SP retains partial activity among pregnant women with asymptomatic parasitaemia, and thus might be useful for IPTp. Nonetheless, research on non-SP IPTp regimens should continue.Trial registrationClinicalTrials.gov NCT01120145.

【 授权许可】

CC BY   
© Gutman et al.; licensee BioMed Central. 2015