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Intermittent Presumptive Treatment in Pregnancy with Sulfadoxine/Pyrimethamine: more than just an antimalarial?

By Sungano Mharakurwa Moderator | 09 Jan, 2017

There is evidence suggesting that intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine/pyrimethamine offers protective efficacy exceeding what is expected from mere antimalarial activity of the drug regimen (see attached article). Should IPTp with SP continue regardless of SP resistance?

Replies

 

Maimunat Alex-Adeomi Moderator Replied at 6:29 PM, 10 Jan 2017

Thank you for this article Sungano. I believe the use of IPTp should continue however, some additional factors that contribute to SP resistance and also those limiting it's use should also be considered. E.g some clinicians avoid the use of S-P due to documented incidence of early trimester miscarriages/abortions due it's use. Some would argue that this could be due to the malaria illness itself, but studies will need to be done to validate this.
More so with a number of women not knowing their LMPs (last menstrual periods) and date of quickening, the optimal use of the IPTp is not achieved and thus abuse and resulting resistance occurs due to sub-optimal use. Long story short, a lot of health education needs to go into it's implementation and use.

Sungano Mharakurwa Moderator Replied at 3:40 PM, 11 Jan 2017

Thanks Maimunat for those thoughts. It seems even more surprising how IPTP-SP gives 26% protective efficacy according to data from 32 countries what with all the other counteracting factors and prevalent resistance. Interestingly, SP-IPTi does have demonstrable reduction of protective efficacy at high levels of antifolate resistance markers (see attached article).

Attached resource:

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