Evaluation of intermittent preventive treatment of malaria against group B Streptococcus colonization in pregnant women: a nested analysis of a randomized controlled clinical trial of sulfadoxine/pyrimethamine versus mefloquine.

Abstract

OBJECTIVES:

Streptococcus agalactiae constitutes an important cause of neonatal infections in sub-Saharan Africa. Sulfadoxine/pyrimethamine-the current intermittent preventive treatment of malaria in pregnancy (IPTp)-has proven in vitro activity against group B Streptococcus (GBS). Because of specific drug resistance to sulfadoxine/pyrimethamine, mefloquine-an antimalarial without in vitro activity against GBS-was evaluated as a potential alternative. This study assessed the potential of sulfadoxine/pyrimethamine-IPTp to reduce the prevalence of GBS colonization in pregnant women in Gabon when compared with the inactive control mefloquine-IPTp.

METHODS:

Pregnant women participating in a randomized controlled clinical trial evaluating mefloquine-IPTp versus sulfadoxine/pyrimethamine-IPTp were invited to participate and recto-vaginal swabs were collected at delivery for detection of GBS colonization. Prevalence of recto-vaginal GBS colonization was compared between IPTp regimens and risk factor and birth outcome analyses were computed.

RESULTS:

Among 549 participants, 106 were positive for GBS colonization at delivery (19%; 95% CI = 16%-23%). Prevalence of maternal GBS colonization showed no significant difference between the two IPTp regimens (mefloquine-IPTp: 67 of 366 women = 18%; 95% CI = 14%-22%; sulfadoxine/pyrimethamine-IPTp: 39 of 183 women = 21%; 95% CI = 15%-27%). Risk factor analysis for GBS colonization demonstrated a significant association with illiteracy (adjusted OR = 2.03; 95% CI = 1.25-3.30). GBS colonization had no impact on birth outcome, anaemia at delivery, gestational age and birth weight.

CONCLUSIONS:

Sulfadoxine/pyrimethamine did not reduce colonization rates when used as the IPTp drug during pregnancy. Illiteracy was associated with GBS colonization.

• Authors: Mesküre Capan-Melser, Ghyslain Mombo Ngoma, Daisy Akerey-Diop, Arti Basra, Heike Würbel, Mirjam Groger, Jean R Mackanga, Rella Zoleko-Manego, Ulla Schipulle, Julia Schwing, Felix Lötsch, Khalid Rehman, Pierre-Blaise Matsiegui, Selidji T Agnandji, Ayôla A Adegnika, Sabine Bélard, Raquel González, Peter G Kremsner, Clara Menendez, Michael Ramharter
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 70 Issue 6 Pg. 1898-902 ( 2015) ISSN: 1460-2091 [Electronic] England
• PMID: 25722300 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• Anti-Bacterial Agents
• Antimalarials
• Drug Combinations
• fanasil, pyrimethamine drug combination
• Sulfadoxine
• Mefloquine
• Pyrimethamine

Topics

• Adolescent
• Adult
• Anti-Bacterial Agents (administration & dosage)
• Antimalarials (administration & dosage)
• Drug Combinations
• Female
• Gabon
• Humans
• Malaria (prevention & control)
• Mefloquine (administration & dosage)
• Pregnancy
• Pregnancy Complications, Infectious (prevention & control)
• Pyrimethamine (administration & dosage)
• Randomized Controlled Trials as Topic
• Rectum (microbiology)
• Streptococcal Infections (microbiology, prevention & control)
• Streptococcus agalactiae (isolation & purification)
• Sulfadoxine (administration & dosage)
• Vagina (microbiology)
• Young Adult