Intermittent preventive antimalaria treatment in infants: still beneficial

  • Esu EB & al.
  • Cochrane Database Syst Rev
  • 2 Dec 2019

  • International Clinical Digest
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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.