Intermittent preventive treatment of malaria in pregnancy: at the crossroads of public health policy

Chico, R. Matthew; Chandramohan, Daniel

doi:10.1111/j.1365-3156.2011.02765.x

Cited by 38Malaria Research and ControlGlobal Maternal and Child HealthHIV/AIDS Research and Interventions

Intermittent preventive treatment of malaria in pregnancy: at the crossroads of public health policy

Chico, R. Matthew, Chandramohan, Daniel·2011·Tropical Medicine & International Health

DOI 10.1111/j.1365-3156.2011.02765.x

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Abstract

Summary: The intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine‐pyrimethamine (SP) has been a key component of the focused antenatal care package for nearly a decade, reducing the burden of low birthweight attributable to malaria in sub‐Saharan Africa. However, SP has lost parasite sensitivity in many sub‐Saharan locations during the same period, rendering its beneficial effect in IPTp debatable. Malaria transmission has also declined in some epidemiological settings. There is no evidence to suggest, however, that the risk of malaria in pregnancy without preventive measures has declined in the same locations. Thus, the urgency to identify efficacious drugs and/or new strategies to prevent malaria in pregnancy remains as great as ever. We summarise the results of recently published SP‐IPTp studies from areas of high drug resistance and/or low malaria transmission. We also present the evidence for mefloquine and azithromycin‐based combinations (ABCs), two leading drug options to replace SP in IPTp. We discuss optimal dosing for ABCs and their likely protection against several sexually transmitted and reproductive tract infections. We also summarise data from a diagnosis‐based alternative to IPTp known as the intermittent screening and treatment (IST) for malaria. Clinical and operational research is urgently needed to compare birth outcomes achieved by IPTp with ABCs vs. IST using an efficacious antimalarial therapy.

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Increasing resistance to mefloquine further restricts treatment options.
“However, the availability of quinine is limited, and increasing resistance to mefloquine further restricts these options [195].”
From Current update on malaria in pregnancy: a systematic review (2025) · cites this paper as [195]
The availability of quinine is limited.
“However, the availability of quinine is limited, and increasing resistance to mefloquine further restricts these options [195].”
From Current update on malaria in pregnancy: a systematic review (2025) · cites this paper as [195]
Malaria treatment options for pregnant women with uncomplicated, chloroquine-resistant P. falciparum or P. vivax infections are limited to mefloquine or quinine plus clindamycin.
“Malaria treatment options for pregnant women with uncomplicated, chloroquine-resistant P.falciparum or P.vivax infections are limited to mefloquine or quinine plus clindamycin.”
From Current update on malaria in pregnancy: a systematic review (2025) · cites this paper as [195]

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Authors: Chico, R. M., & Chandramohan, D.
Affiliations: London School of Hygiene & Tropical Medicine (GB)
Corresponding author: Chico, R. Matthew
ORCID: Chico, R. Matthew
Chandramohan, Daniel
Venue: Tropical Medicine & International Health
Publisher: Wiley
Published: 2011-04-07
Volume: 16
Issue: 7
Pages: 774-785
ISSN: 1360-2276 (ISSN-L)
1365-3156
DOI: 10.1111/j.1365-3156.2011.02765.x
OpenAlex: W1573701953
Cited by: 38
References: 89
Citations by year: 2026: 1 · 2025: 1 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 3 · 2014: 2 · 2013: 5 · 2012: 8
FWCI: 0.87
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Tropical Medicine & International Health (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords: intermittent preventive treatment in pregnancy, sulfadoxine-pyrimethamine, mefloquine, intermittent screening and treatment, antimalarial drug resistance, malaria in pregnancy, low birth weight, focused antenatal care, sexually transmitted infections, reproductive tract infections, malaria transmission, sub-Saharan Africa, public health policy
MeSH terms: Adult, Antimalarials, Clinical Trials as Topic, Drug Administration Schedule, Drug Combinations, Drug Resistance, Drug Therapy, Combination, Female, Humans, Malaria, Pregnancy, Prenatal Care, Public Health, Pyrimethamine, Sexually Transmitted Diseases, Sulfadoxine, Pregnancy Complications, Parasitic, Mefloquine, Treatment Outcome, AIDS-Related Opportunistic Infections, Africa South of the Sahara, Azithromycin, Anti-HIV Agents

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Intermittent preventive treatment of malaria in pregnancy: at the crossroads of public health policy

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