Abstract
BackgroundMalaria prophylaxis is recommended for persons with sickle cell disease (SCD), but the value of this has been questioned. The aim of this study was to find out whether intermittent preventive treatment (IPT) with a fixed-dose combination of mefloquine-artesunate (MQAS) or sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) was more effective than daily proguanil for malaria prevention in subjects with SCD.MethodsPatients with SCD were randomized to receive daily treatment with proguanil or IPT with either MQAS or SPAQ once every 2 months at routine clinic visits. Patients were followed up for 14 months.FindingsA total of 270 patients with SCD were studied, with 90 in each group. Adherence to the IPT regimens was excellent, but 57% of patients took <75% of their daily doses of proguanil. IPT was well tolerated; the most common side effects were vomiting and abdominal pain. Protective efficacy against malaria, compared with daily proguanil, was 61% (95% confidence interval, 3%–84%) for MQAS and 36% (40%–70%) for SPAQ. There were fewer outpatient illness episodes in children who received IPT than those who received proguanil.ConclusionsIPT with MQAS administered to patients with SCD during routine clinic visits was well tolerated and more effective in preventing malaria than daily prophylaxis with proguanil.Clinical Trials RegistrationNCT01319448 and ISRCTN46158146.
Highlights
Malaria prophylaxis is recommended for persons with sickle cell disease (SCD), but the value of this has been questioned
intermittent preventive treatment (IPT) with MQAS administered to patients with SCD during routine clinic visits was well tolerated and more effective in preventing malaria than daily prophylaxis with proguanil
The incidence of Plasmodium falciparum infection is thought to be lower in children with sickle cell disease (SCD) than in normal children [1], the consequence of malaria in SCD can be serious
Summary
The aim of this study was to find out whether intermittent preventive treatment (IPT) with a fixed-dose combination of mefloquine-artesunate (MQAS) or sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) was more effective than daily proguanil for malaria prevention in subjects with SCD
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