Parise M E, Ayisi J G, Nahlen B L, Schultz L J, Roberts J M, Misore A, Muga R, Oloo A J, Steketee R W
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Am J Trop Med Hyg. 1998 Nov;59(5):813-22. doi: 10.4269/ajtmh.1998.59.813.
A fever case management (CM) approach using sulfadoxine-pyrimethamine (SP) was compared with two presumptive intertmittent SP treatment regimens in the second and third trimesters in pregnant primigravidae and secundigravidae in an area of intense Plasmodium falciparum malaria transmission in western Kenya. The investigation evaluated efficacy of the antimalarial regimens for prevention of placental malaria and examined the effect of human immunodeficiency virus (HIV) infection on antimalarial drug efficacy and adverse drug reactions. Twenty-seven percent (93 of 343) of pregnant women in the CM group had placental malaria compared with 12% (38 of 330; P < 0.001) of women who received two doses of SP and compared with 9% (28 of 316; P < 0.001) of women who received monthly SP. Fourteen percent (49 of 341) of women in the CM group delivered low birth weight (LBW) infants compared with 8% (27 of 325; P=0.118) of women who received two doses of SP and compared with 8% (26 of 331; P=0.078) of women who received monthly SP. Seven percent (7 of 99) of the HIV-negative women on the two-dose SP regimen had placental malaria compared with 25% (10 of 39; P=0.007) of HIV-positive women on the same regimen; the rate of placental malaria in HIV-positive women was reduced to 7% (2 of 28; P=-0.051) for women on the monthly SP regimen. Less than 2% of women reported adverse drug reactions, with no statistically significant differences between HIV-positive and HIV-negative women. Intermittent treatment with SP is safe and efficacious for the prevention of placental malaria in pregnant primigravidae and secundigravidae in sub-Saharan Africa. While a two-dose SP regimen may be effective in areas with low HIV seroprevalence, administration of SP monthly during the second and third trimesters of pregnancy should be considered in areas of high HIV seroprevalence to prevent the effects of maternal malaria on the newborn.
在肯尼亚西部恶性疟原虫高度传播的地区，对初产妇和经产妇在妊娠中期和晚期采用周效磺胺-乙胺嘧啶（SP）进行发热病例管理（CM）的方法，与两种推定的间歇性SP治疗方案进行了比较。该调查评估了抗疟方案预防胎盘疟疾的疗效，并研究了人类免疫缺陷病毒（HIV）感染对抗疟药物疗效和药物不良反应的影响。CM组27%（343例中的93例）的孕妇患有胎盘疟疾，接受两剂SP的妇女中这一比例为12%（330例中的38例；P<0.001），接受每月一次SP的妇女中这一比例为9%（316例中的28例；P<0.001）。CM组14%（341例中的49例）的妇女分娩低体重（LBW）婴儿，接受两剂SP的妇女中这一比例为8%（325例中的27例；P=0.118），接受每月一次SP的妇女中这一比例为8%（331例中的26例；P=0.078）。接受两剂SP方案的HIV阴性妇女中有7%（99例中的7例）患有胎盘疟疾，而同一方案的HIV阳性妇女中这一比例为25%（39例中的10例；P=0.007）；对于接受每月一次SP方案的妇女，HIV阳性妇女的胎盘疟疾发生率降至7%（28例中的2例；P=-0.051）。不到2%的妇女报告有药物不良反应，HIV阳性和HIV阴性妇女之间无统计学显著差异。在撒哈拉以南非洲，对初产妇和经产妇间歇性使用SP预防胎盘疟疾是安全有效的。虽然两剂SP方案在HIV血清阳性率低的地区可能有效，但在HIV血清阳性率高的地区，应考虑在妊娠中期和晚期每月给予SP，以预防母体疟疾对新生儿的影响。
