The Comparative Effects of Antenatal Azithromycin and Sulfadoxine-pyrimethamine on Maternal Malaria during Pregnancy

Abstract

Background Malaria during pregnancy causes significant maternal and perinatal morbidities and mortality. The World Health Organization recommends intermittent preventive treatment with sulfadoxine-pyrimethamine (SP). The reports of SP resistance have prompted the need for alternatives. Objective This study compared the effects of azithromycin (AZ) and SP on maternal malaria during pregnancy among pregnant women in Owo, Ondo State. Methods and Materials A prospective randomized controlled trial was conducted among 322 pregnant women who presented for antenatal care and delivery at Federal Medical Centre, Owo, Ondo State. 500 mg AZ was administered to 148 participants on three consecutive days at intervals of every four weeks, whereas 143 participants received SP in accordance with the standard regimen. Data were analyzed using descriptive and inferential statistics at a 5% level of significance, and outcomes were compared across groups using Chi-square and Student’s t-test. Results The incidence of asymptomatic parasitaemia was 17.2%. Following the administration of the trial drugs, the rates of maternal parasitaemia did not show any statistically significant difference at antenatal follow-up (9 [6.3%] for SP and 12 [8.1%] for AZ [P = 0.360]) and at delivery in both the groups (7 [4.9%] for SP and 5 [3.4%] for AZ [P = 0.360]). The incidence of adverse events and pregnancy outcomes were also comparable between both groups. AZ compared effectively with SP in reducing the risk of having symptomatic malaria during pregnancy. There was no significant difference in maternal peripheral parasitaemia between the two groups. Conclusion Hence, AZ could be considered an alternative to SP for intermittent preventive treatment of malaria during pregnancy.

Keywords

• azithromycin
• intermittent preventive treatment for malaria in pregnancy
• sulfadoxine-pyrimethamine