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Intermittent preventive therapy for malaria: progress and future directions

Grobusch, Martin Pa,b; Egan, Andreac; Gosling, Roly Dd; Newman, Robert De

Current Opinion in Infectious Diseases: December 2007 - Volume 20 - Issue 6 - p 613–620
doi: 10.1097/QCO.0b013e3282f1ae3b
Antimicrobial agents: parasitic/viral: Edited by Simon Croft and Deenan Pillay

Purpose of review: This review summarizes recent evidence regarding the efficacy of intermittent preventive treatment with focus on infancy (IPTi) and the rationale behind such a control strategy.

Recent findings: Pooled safety and efficacy analyses of all six trials of IPTi with sulfadoxine-pyrimethamine conducted between 1999 and 2007 have demonstrated a 30% protective efficacy against clinical malaria, a 24% protective efficacy against all-cause hospital admissions, a 37% protective efficacy against malaria-related hospital admissions, and a 15% protective efficacy against anemia, all in the first year of life. Rebound in malaria following discontinuation of the intervention has not been noted in pooled analyses of the IPTi trials.

Summary: Given the efficacy, excellent safety and tolerability of the intervention and the fact that it is inexpensive and easily deliverable if linked to the Expanded Programme on Immunization, IPTi-sulfadoxine-pyrimethamine appears to add a valuable tool to the malaria-control armamentarium in endemic areas of Africa. Routine monitoring of sulfadoxine-pyrimethamine efficacy will be required to guide future IPTi programme implementation. Variations of IPTi that target older children may be required for areas of Africa with highly seasonal malaria transmission.

aInfectious Diseases Unit, Division of Clinical Microbiology and Infectious Diseases, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa

bMedical Research Unit, Hôpital Albert Schweitzer, Lambaréné, Gabon, Spain

cIntermittent Preventive Treatment of malaria in infants (IPTi) Consortium, Centre de Salut Internacional, Hospital Clinic, Universitat de Barcelona, Spain

dDepartment of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK

eMalaria Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Correspondence to Professor Martin Grobusch, Infectious Diseases Unit, Division of Clinical Microbiology and Infectious Diseases, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa Tel: +27 11 489 8537; fax: +27 11 489 8511; e-mail: martin.grobusch@wits.ac.za

© 2007 Lippincott Williams & Wilkins, Inc.