Abstract
BackgroundA reduction in the therapeutic efficacy of chloroquine (CQ) and sulphadoxine-pyrimethamine (SP) has recently been observed in Burkina Faso. As these two drugs are used in pregnancy, their efficacy in pregnant women was studied to directly assess the level of drug resistance in this specific population, rather than to extrapolate results of studies conducted in children < 5 years of age.MethodsDuring the malaria transmission season of 2003 in Ouagadougou, the clinical efficacy of SP and CQ, using the WHO 28-day protocol, was assessed in primigravidae and secundigravidae presenting with uncomplicated malaria.ResultsPCR-corrected results by day 28 showed that among 62 women treated with SP, eight (12.9%) experienced late parasitological failure, but no clinical failures. Among 60 women treated with CQ, the overall failure rate was 46.7% including 1.7% early treatment failures, 5% late clinical failures and 40% late parasitological failures. SP induced a haemoglobin gain of 0.3 g/dL by day 14 and 0.9 g/dL by day 28. Treatment responses were independent of gravidity, gestational age and prior antenatal care visits.ConclusionWhile CQ should no longer be used, the efficacy of SP is still compatible with use for intermittent preventive treatment (IPT) in pregnancy. However, given the possible spread of resistance, the drug should be restricted in its use.
Highlights
A reduction in the therapeutic efficacy of chloroquine (CQ) and sulphadoxinepyrimethamine (SP) has recently been observed in Burkina Faso
A new malaria treatment policy was formulated in February 2005, whereby CQ was replaced by arthemether/lumefantrine (Coartem) as first-line drug for uncomplicated malaria, while intermittent preventive treatment (IPT) with SP was introduced to replace CQ prophylaxis in pregnancy
General characteristics of pregnant women recruited for the trial Among 943 primigravidae and secundigravidae who consulted Antenatal Care (ANC) or outpatient department (OPD) between September 21st and December 8th 2003, 255 were in the second or third trimester of pregnancy and presented with symptoms and signs leading to a presumptive diagnosis of acute and uncomplicated malaria and were screened for malaria infection
Summary
A reduction in the therapeutic efficacy of chloroquine (CQ) and sulphadoxinepyrimethamine (SP) has recently been observed in Burkina Faso. As these two drugs are used in pregnancy, their efficacy in pregnant women was studied to directly assess the level of drug resistance in this specific population, rather than to extrapolate results of studies conducted in children < 5 years of age. When implementing new treatment and prevention policies, particular interest should be given to pregnant women as the number of antimalarial drugs safe to be used in pregnancy is limited. A new malaria treatment policy was formulated in February 2005, whereby CQ was replaced by arthemether/lumefantrine (Coartem) as first-line drug for uncomplicated malaria, while intermittent preventive treatment (IPT) with SP was introduced to replace CQ prophylaxis in pregnancy. SP has, rarely been used for case management in pregnancy and, its efficacy in treating malaria in pregnant women is not known
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