Abstract
In the high malaria-transmission settings of sub-Saharan Africa, malaria in pregnancy is an important cause of maternal, perinatal and neonatal morbidity. Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) reduces the incidence of low birth-weight, pre-term delivery, intrauterine growth-retardation and maternal anaemia. However, the public health benefits of IPTp are declining due to SP resistance. The combination of azithromycin and chloroquine is a potential alternative to SP for IPTp. This review summarizes key in vitro and in vivo evidence of azithromycin and chloroquine activity against Plasmodium falciparum and Plasmodium vivax, as well as the anticipated secondary benefits that may result from their combined use in IPTp, including the cure and prevention of many sexually transmitted diseases. Drug costs and the necessity for external financing are discussed along with a range of issues related to drug resistance and surveillance. Several scientific and programmatic questions of interest to policymakers and programme managers are also presented that would need to be addressed before azithromycin-chloroquine could be adopted for use in IPTp.
Highlights
Each year, 30 million pregnancies are at risk of malaria infection in sub-Saharan Africa, representing a major public health problem
This review summarizes in vitro and in vivo evidence for the therapeutic efficacy of azithromycin and chloroquine when used alone or together and discusses the additional benefits that the combination could have on many sexually transmitted diseases and, possibly, pneumococcal infection during pregnancy
Treatment trials with the azithromycin-chloroquine combination in Africa A double-blinded multi-centre trial was held in Burkina Faso, Ghana Mali, Kenya, Uganda, and Zambia to compare the therapeutic efficacy and tolerability of azithromycin-chloroquine with that of mefloquine [71]; a second, http://www.malariajournal.com/content/7/1/255 open-label, confirmatory trial was conducted in the same countries, with the addition of Senegal [72]
Summary
30 million pregnancies are at risk of malaria infection in sub-Saharan Africa, representing a major public health problem. Treatment trials with the azithromycin-chloroquine combination in Africa A double-blinded multi-centre trial was held in Burkina Faso, Ghana Mali, Kenya, Uganda, and Zambia to compare the therapeutic efficacy and tolerability of azithromycin-chloroquine with that of mefloquine [71]; a second, http://www.malariajournal.com/content/7/1/255 open-label, confirmatory trial was conducted in the same countries, with the addition of Senegal [72] Together, these studies established an efficacious treatment course for azithromycin-chloroquine against uncomplicated P. falciparum infection: a fixed daily dose of 1,000 mg of azithromycin and 600 mg of chloroquine taken for three days. It is possible that two or three IPTp treatments with azithromycin-chloroquine could offer women some protection against HIV infection in pregnancy, but the observable difference may be undetectable due to sample size limitations in most clinical trials, especially in areas with low HIV prevalence rates. MTCT or post-partum transmission among sero-positive women who choose to breastfeed?
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