Intermittent preventive antimalaria treatment in infants: still beneficial

Takeaway

• Intermittent preventive treatment of infants (IPTi) with sulfadoxine‐pyrimethamine (SP) remains linked to reduced malaria risk, although the effect has faded recently.
• IPTi with artemisinin-based combination therapies (ACTs) shows promise in reducing malaria risk in this population in sub-Saharan Africa and may reduce proportion with parasites in their blood.

Why this matters

• These authors say that with the efficacy attenuation seen with SP, IPTi with other combinations may show greater effect.
• Continued use of SP warrants ongoing monitoring for resistance, they say.

Key results

• IPTi overall: reduced clinical malaria by 27%.
• Rate ratio (RR): 0.73 (95% CI, 0.65-0.82).
• IPTi with SP (10 trials):
  • Fewer episodes of clinical malaria: 0.79, 0.74 to 0.85;
  • Less anemia: 0.82, 0.68 to 0.98.
  • Less parasitemia: 0.66, 0.56 to 0.79.
  • Little effect on mortality:  0.93, 0.74 to 1.15.
  • All moderate-certainty evidence.
• Post-2009 trials little to no effect.
• IPTi with ACT (3 publications):
  • Reduced clinical malaria: RR, 0.42, 0.33 to 0.54 (only 1 trial).
  • Reduced parasitemia also seen.

Study design

• 12 trials included, with 19,098 infants, all in sub-Saharan African countries.
• Funding: University of Calabar, Nigeria; others.

Limitations

• Only 3 studies available for ACT.
• Other limitations relate to those of the original studies.