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A COMPARATIVE STUDY OF AZITHROMYCIN AND SULPHADOXINE-PYRIMETHAMINE AS PROPHYLAXIS AGAINST MALARIA IN PREGNANCY
Abstract
INTRODUCTION: Malaria infection in pregnancy (MIP) remains a public health problem in the tropical and subtropical regions of the world with ninety percent of the global malaria burden occurring in Sub-Saharan Africa. The risks of malaria infection are greatest in primigravidae and decrease with increasing parity; with multi-parous women being less affected. In order to reduce the burden of malaria infections, several interventions have been recommended by the World Health Organization for the control of malaria infection. These include, the use of insecticide treated nets (ITN), intermittent preventive treatment for malaria in pregnancy (IPTp) and prompt case management of malaria illness. The benefit of IPTp is however threatened by the emergence of Plasmodium falciparum resistance to known anti-malarial agents for chemoprophylaxis and treatment.
OBJECTIVES: The main objective of this study was to compare the efficacy of azithromycin with Sulphadoxine-pyrimethamine for intermittent preventive treatment of malaria in pregnancy (IPTp).
METHODOLOGY: This was a prospective comparative study conducted at the University College Hospital, Ibadan over a period of eight months from November 2011 to July 2012, among pregnant women attending antenatal clinic. The participants were randomized into two groups- group one participants received sulphadoxinepyrimethamine while group two participants received azithromycin. A data collection form was completed for each participant; they were followed up and blood samples collected at intervals for evaluation of malaria parasitaemia;
maternal peripheral blood film, placental and cord blood samples were also collected at delivery. The data collected was entered, cleaned and computer analysed using SPSS version 16.
RESULTS: A total of two hundred and thirty (230) participants were enrolled into the study with one hundred and fifteen (115) participants allocated into each study group – Sulphadoxine-pyrimethamine (SP) and azithromycin. Of the two hundred and thirty (100%) participants recruited, one hundred and sixty-six participants (72.2%) completed the study; sixty-four (27.8%) participants were lost to follow up. The results from this study suggests equal efficacy of Azithromycin compared with Sulphadoxine-Pyrimethamine in the prevention of malaria in pregnancy. This was demonstrated by the finding of few positive results of peripheral, placental and cord blood parasitaemia. The fetal and maternal outcomes for the two study groups were comparable and azithromycin was well tolerated.
CONCLUSION: The results of this study suggest that azithromycin may be as effective as sulphadoxine-pyrimethamine in the intermittent preventive treatment of malaria in pregnancy and may be used for the intermittent preventive treatment of malaria in pregnancy in patients who do not tolerate Sulphadoxine-pyrimethamine.
