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• Dihydroartemisinin-piperaquine for intermittent preventive treatment of malaria during pregnancy (March 2016, Modified March 2016)

For pregnant women who live in areas with medium and high malaria transmission, we agree with the World Health Organization (WHO) strategy to provide intermittent preventive treatment during pregnancy (IPTp). Sulfadoxine-pyrimethamine (SP) has been an effective drug for IPT, although its benefit may be limited given the emergence of drug resistance. Two trials in Kenya and Uganda (where SP resistance is widespread) have evaluated the efficacy of dihydroartemisinin-piperaquine (DP) for IPTp:

 In a trial including over 1500 Kenyan women randomly assigned to receive IPT with SP or DP, IPT with DP resulted in a lower prevalence of malaria infection at delivery (3 versus 10 percent) and fewer episodes of clinical malaria during pregnancy (38 versus 6 episodes) compared with IPT with SP [10]. The trial was not powered to detect small differences in neonatal outcomes.

 In a trial including 300 pregnant adolescents and women in Uganda randomly assigned to receive IPT with SP (three doses), DP (three doses), or DP (monthly treatments starting as early as 16 weeks of gestation) [11], the prevalence of histopathologically confirmed placental malaria was lower among those who received monthly DP (27 percent) than among those who received three doses of DP (34 percent) or IPT with SP (50 percent). In addition, monthly DP treatment was superior to three-dose DP with regard to several outcomes, including adverse birth outcomes and the incidence of symptomatic malaria.


DP is a promising alternative agent for IPTp; further study of DP dosing in pregnancy is needed. (See "Prevention and treatment of malaria in pregnant women", section on 'Intermittent preventive treatment during pregnancy'.)

     

 
     

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