Intermittent preventive treatment of malaria in infants

Esu EB, Oringanje C, Meremikwu MM Intermittent preventive treatment of malaria in infants. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD011525. doi: 10.1002 /14651858.CD011525.pub3. Accessed July 29, 2021.

Commentary

This study was designed to evaluate the efficacy of intermittent preventive treatment (IPT) with antimalarial drugs for malaria prevention in infants living in malaria-endemic areas.

The main results of the study were reviewed, including 12 trials that enrolled 19,098 infants, all of which were conducted in sub-Saharan Africa. Three of these were cluster RCTs, and IPTi, including sulfadoxine-pyrimethamine (SP), was evaluated in 10 trials from 1999-2013 (n = 15,256).

The studies evaluating ACT included.

Dihydroartemisinin-piperaquine (1 study, 147 participants, 2013)

Amodiaquine-Artesunate (1 study, 684 participants, 2008)

SP-artesunate (1 study, 676 participants, 2008)

are included in this study.

Early studies used SP to assess IPTi and

Tanzania (1999 and 2006)

Mozambique (2004)

Ghana (2004-2005)

Gabon (2005)

Kenya (2008)

Kenya (2008) ・Mali (2009)

Some trials have been conducted in Tanzania. One study evaluated IPTi with amodiaquine in Tanzania (2000), and subsequent studies include three studies conducted in Kenya (2008), Tanzania (2008), and Uganda (2013).

Although effect sizes vary over time and by drug, overall IPTi has been found to have an overall impact on clinical malaria incidence, reducing it by 30%. The effect of SP seems to decay over time, and trials conducted since 2009 have shown little or no effect of the intervention.

Since 2009, the IPTi trial has evaluated ACTs and shown effects on clinical malaria and parasitaemia, and a small trial of DHAP in 2013 has shown substantial effects on clinical malaria and parasitaemia.

The authors conclude that

In sub-Saharan Africa, IPT may reduce the risk of clinical malaria, anemia, and hospitalization, so infants are given antimalarial drugs known to be effective against the malaria parasite at the time Evidence from the SP study over 19 years shows a decline in efficacy. This may be due to increased drug resistance; the combination with ACTs appears to be a promising and appropriate alternative to IPTi.