J Travel Med. 2025 Oct 22:taaf112. doi: 10.1093/jtm/taaf112. Online ahead of print.
ABSTRACT
BACKGROUND: In malaria-endemic regions, escalating sulfadoxine-pyrimethamine (SP) resistance has raised concerns about the effectiveness of intermittent preventive therapy (IPTp) in pregnant women. Consequently, exploring IPTp alternatives has become an urgent priority in this population. Azithromycin (AZ) has garnered attention in this aspect due to its capability to treat sexually transmitted infections and its established safety profile.
METHODS: A systematic literature search was conducted in the PubMed, Embase, CINAHL, Scopus, and Cochrane Library databases as of March 14th, 2024. We included randomized controlled trials (RCTs) comparing AZ-containing IPTp regimens with AZ-lacking regimens. Both pairwise and network meta-analyses (NMA) assessed their efficacy and safety. The NMA used a frequentist approach using the Mantel-Haenszel method to determine the optimal regimen for the primary outcome, peripheral blood parasitemia at delivery. Secondary outcomes encompassed adverse pregnancy outcomes (i.e., preterm birth, low birth weight, neonatal death, fetal loss, and small for gestational age), maternal anemia at delivery, and safety profiles.
FINDINGS: We included eight RCTs conducted in moderate SP resistance areas. The meta-analysis revealed that AZ-containing regimens reduced the risk of peripheral parasitemia at delivery compared to AZ-lacking IPTp-SP regimens (odds ratio [OR] 0·71, 95% confidence interval [CI] 0·57-0·88). No significant differences were noted between groups for other secondary outcomes. Regarding adverse events, AZ-containing IPTp regimens exhibited a safety profile similar to SP-based IPTp regimens without AZ (OR 1·11, 95% CI 0·76-1·62).
CONCLUSION: AZ-containing IPTp regimens reduce rates of parasitemia at delivery compared to WHO-recommended IPTp-SP regimens or other SP-containing regimens without AZ. Adding AZ to the standard IPTp-SP regimen holds promising potential considering the escalating SP resistance, the safety profile of AZ, and its additional coverage of sexually transmitted pathogens.
PMID:41123563 | DOI:10.1093/jtm/taaf112
