Safety and Toxicity of Sulfadoxine/Pyrimethamine: Implications for Malaria Prevention in Pregnancy using Intermittent Preventive Treatment
Abstract
Plasmodium falciparum infection during pregnancy is strongly associated with maternal anaemia and low birth weight, contributing to substantial morbidity and mortality in sub-Saharan Africa. Intermittent preventive treatment in pregnancy with sulfadoxine/pyrimethamine (IPTp-SP) has been one of the most effective approaches to reduce the burden of malaria during pregnancy in Africa. IPTp-SP is based on administering >or=2 treatment doses of sulfadoxine/pyrimethamine to pregnant women at predefined intervals after quickening (around 18-20 weeks). Randomised, controlled trials have demonstrated decreased rates of maternal anaemia and low birth weight with this approach. The WHO currently recommends IPTp-SP in malaria-endemic areas of sub-Saharan Africa. However, implementation has been suboptimal in part because of concerns of potential drug toxicities. This review evaluates the toxicity data of sulfadoxine/pyrimethamine, including severe cutaneous adverse reactions, teratogenicity and alterations in bilirubin metabolism. Weekly sulfadoxine/pyrimethamine prophylaxis is associated with rare but potentially fatal cutaneous reactions. Fortunately, sulfadoxine/pyrimethamine use in IPTp programmes in Africa, with 2-4 treatment doses over 6 months, has been well tolerated in multiple IPTp trials. However, sulfadoxine/pyrimethamine should not be administered concurrently with cotrimoxazole given their redundant mechanisms of action and synergistic worsening of adverse drug reactions. T…
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IPTp is not given during the first five months of pregnancy and thus cannot protect women during the early phase of pregnancy.
“Currently, IPTp is not given during the first five months of pregnancy, and thus is not able to protect women during the early phase of pregnancy (Peters et al. , 2007)”
From Towards a vaccine against pregnancy-associated malaria (2008) · cites this paper as Peters et al., 2007
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References 175 · Cited by 174
- Authors
- Peters, P. J., Thigpen, M. C., Parise, M. E., & Newman, R. D.
- Affiliations
- Emory University (US)
- Corresponding author
- Peters, Philip J
- Venue
- Drug Safety
- Published
- 2007
- Volume
- 30
- Issue
- 6
- Pages
- 481-501
- ISSN
- 0114-5916 (ISSN-L)
- OpenAlex
- W2045936441
- Cited by
- 174
- References
- 175
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 10 · 2023: 6 · 2022: 8 · 2021: 12 · 2020: 8 · 2019: 3 · 2018: 8 · 2017: 9 · 2016: 12 · 2015: 11 · 2014: 10 · 2013: 9 · 2012: 8
- FWCI
- 12.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drug Safety (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- sulfadoxine-pyrimethamine, intermittent preventive treatment in pregnancy, malaria in pregnancy, drug toxicity, drug-induced skin reaction, teratogenicity, neural tube defects, folic acid supplementation, kernicterus, bilirubin metabolism, trimethoprim-sulfamethoxazole, anemia in pregnancy, low birth weight, antimalarial drug efficacy, antifolate, HIV in pregnancy
- MeSH terms
- Abnormalities, Drug-Induced, Africa, Animals, Antimalarials, Drug Administration Schedule, Drug Combinations, Drug Resistance, Female, Humans, Infant, Newborn, Kernicterus, Plasmodium falciparum, Pregnancy, Pyrimethamine, Sulfadoxine, Pregnancy Complications, Parasitic, Malaria, Falciparum
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