Revisiting Azithromycin for Intermittent Preventive Treatment in Pregnancy

In malaria-endemic regions of Africa, the World Health Organization recommends pregnant women receive intermittent preventive treatment in pregnancy (IPTp), which entails providing full treatment courses of a long-acting antimalarial from the second trimester to delivery, with doses given at least one month apart. Sulfadoxine-pyrimethamine (SP) is the only antimalarial currently recommended for IPTp, but its antimalarial efficacy is threatened by the emergence and spread of SP resistance. Azithromycin (AZ) has been considered as a potential partner drug for IPTp, with the aim of strengthening antimalarial protection while also impacting on other factors associated with adverse birth outcomes. Several clinical trials of AZ-containing IPTp regimens have been conducted, including combinations of AZ with SP,2- chloroquine, dihydroartemisinin-piperaquine (DP),7 piperaquine, and trimethroprim-sulfamethoxazole.