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Effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine: An in silico pharmacological model
Mila Nu Nu Htay1, Ian M Hastings2, Eva Maria Hodel3, Katherine Kay4
1 Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom; Department of Community Medicine, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
2 Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom
3 Liverpool School of Tropical Medicine, Liverpool L3 5QA; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; University of Liverpool, Liverpool L69 3GF, United Kingdom
4 Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom; Metrum Research Group , Tariffville, Connecticut, 06081, United States of America
Correspondence Address:
Mila Nu Nu Htay
Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom; Department of Community Medicine, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
 Source of Support: This work was funded by the Bill and Melinda Gates Foundation
(grant No. 37999.01) and the Medical Research Council (grant
No. G110052) and supported by the Liverpool School of Tropical
Medicine, Conflict of Interest: None
DOI: 10.4103/1995-7645.289441
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Objective: To explore the efficacy of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine and pyrimethamine (SP) against sensitive parasites.
Methods: A pharmacological model was used to investigate the effectiveness of the previous recommended at least two-dose regimen, currently recommended three-dose regimen and 4, 6, 8-weekly regimens with specific focus on the impact of various non-adherence patterns in multiple transmission settings.
Results: The effectiveness of the recommended three-dose regimen is high in all the transmission intensities, i.e. >99%, 98% and 92% in low, moderate and high transmission intensities respectively. The simulated 4 and 6 weekly IPTp-SP regimens were able to prevent new infections with sensitive parasites in almost all women (>99%) regardless of transmission intensity. However, 8 weekly interval dose schedules were found to have 71% and 86% protective efficacies in high and moderate transmission areas, respectively. It highlights that patients are particularly vulnerable to acquiring new infections if IPTp-SP doses are missed.
Conclusions: The pharmacological model predicts that full adherence to the currently recommended three-dose regimen should provide almost complete protection from malaria infection in moderate and high transmission regions. However, it also highlights that patients are particularly vulnerable to acquiring new infections if IPTp doses are spaced too widely or if doses are missed. Adherence to the recommended IPTp-SP schedules is recommended.
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