Journal of travel medicine · 2026
Safety and efficacy of azithromycin-containing regimen as an intermittent preventive therapy for malaria in pregnant women: a systematic review and meta-analysis of randomized controlled trials.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Lin I-Fan, Sulaiman Helmi, Tran Van Khoi, Basri Sazali, Pham Chi Thanh, Nguyen Ly Minh Duy, Tey Mei Ying, Wu Mph Chun Lok, Tam Ka-Wai, Loh El-Wui
Аннотация
BACKGROUND: In malaria-endemic regions, escalating sulfadoxine-pyrimethamine (SP) resistance has raised concerns about the effectiveness of intermittent preventive therapy (IPTp) in pregnant women. Consequently, exploring IPTp alternatives has become an urgent priority in this population. Azithromycin (AZ) has garnered attention in this aspect due to its capability to treat sexually transmitted infections and its established safety profile.
METHODS: A systematic literature search was conducted in the PubMed, Embase, CINAHL, Scopus and Cochrane Library databases as of 14 March 2024. We included randomized controlled trials (RCTs) comparing AZ-containing IPTp regimens with AZ-lacking regimens. Both pairwise and network meta-analyses (NMA) assessed their efficacy and safety. The NMA used a frequentist approach using the Mantel-Haenszel method to determine the optimal regimen for the primary outcome, peripheral blood parasitemia at delivery. Secondary outcomes encompassed adverse pregnancy outcomes (i.e., preterm birth, low birth weight, neonatal death, fetal loss and small for gestational age), maternal anaemia at delivery and safety profiles.
FINDINGS: We included eight RCTs conducted in moderate SP resistance areas. The meta-analysis revealed that AZ-containing regimens reduced the risk of peripheral parasitemia at delivery compared to AZ-lacking IPTp-SP regimens (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.57-0.88). No significant differences were noted between groups for other secondary outcomes. Regarding adverse events, AZ-containing IPTp regimens exhibited a safety profile similar to SP-based IPTp regimens without AZ (OR 1.11, 95% CI 0·76-1·62).
CONCLUSION: AZ-containing IPTp regimens reduce rates of parasitemia at delivery compared to WHO-recommended IPTp-SP regimens or other SP-containing regimens without AZ. Adding AZ to the standard IPTp-SP regimen holds promising potential considering the escalating SP resistance, the safety profile of AZ and its additional coverage of sexually transmitted pathogens.
METHODS: A systematic literature search was conducted in the PubMed, Embase, CINAHL, Scopus and Cochrane Library databases as of 14 March 2024. We included randomized controlled trials (RCTs) comparing AZ-containing IPTp regimens with AZ-lacking regimens. Both pairwise and network meta-analyses (NMA) assessed their efficacy and safety. The NMA used a frequentist approach using the Mantel-Haenszel method to determine the optimal regimen for the primary outcome, peripheral blood parasitemia at delivery. Secondary outcomes encompassed adverse pregnancy outcomes (i.e., preterm birth, low birth weight, neonatal death, fetal loss and small for gestational age), maternal anaemia at delivery and safety profiles.
FINDINGS: We included eight RCTs conducted in moderate SP resistance areas. The meta-analysis revealed that AZ-containing regimens reduced the risk of peripheral parasitemia at delivery compared to AZ-lacking IPTp-SP regimens (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.57-0.88). No significant differences were noted between groups for other secondary outcomes. Regarding adverse events, AZ-containing IPTp regimens exhibited a safety profile similar to SP-based IPTp regimens without AZ (OR 1.11, 95% CI 0·76-1·62).
CONCLUSION: AZ-containing IPTp regimens reduce rates of parasitemia at delivery compared to WHO-recommended IPTp-SP regimens or other SP-containing regimens without AZ. Adding AZ to the standard IPTp-SP regimen holds promising potential considering the escalating SP resistance, the safety profile of AZ and its additional coverage of sexually transmitted pathogens.