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TitleInferiority of Single-Dose Sulfadoxine-Pyrimethamine Intermittent Preventive Therapy for Malaria during Pregnancy among HIV-Positive Zambian Women
AuthorsGill C. J., Macleod W. B., Mwanakasale V., Chalwe V., Mwananyanda L., Champo D., Mukwamataba D., Chilengi R., Thea D. M., Hamer D. H.
PublicationJ Infect Dis. 2007 Nov; 196(11):1577-84.
AbstractBACKGROUND: The World Health Organization advocates 2-3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (SP IPTp). The optimal number of doses and the consequences of single-dose therapy remain unclear. METHODS: Data were from a randomized, controlled study of human immunodeficiency virus-positive Zambian women comparing monthly versus 2-dose SP IPTp. We compared maternal and neonatal birth outcomes as a function of how many doses the mothers received (1 to > or =4 doses). RESULTS: Of 387 deliveries, 34 received 1 dose of SP. Single-dose SP was significantly associated with higher proportions of maternal anemia, peripheral and cord blood parasitemia, infant prematurity, and low birth weight. SP conferred dose-dependent benefits, particularly in the transition from 1 to 2 doses of SP. Women randomized to the standard 2-dose regimen were much more likely to receive only 1 dose than were women randomized to monthly IPT (relative risk, 16.4 [95% confidence interval, 4.0-68.3]). CONCLUSIONS: Single-dose SP was a common result of trying to implement the standard 2-dose regimen and was inferior to all other dosing regimens. At a programmatic level, this implies that monthly SP IPTp may ultimately be more effective than the standard regimen by reducing the risk of inadvertently underdosing mothers.
URLhttp://www.ncbi.nlm.nih.gov/pubmed/18008240
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