Pharmacokinetic considerations in seasonal malaria chemoprevention. Issue 8 (August 2022)

• Record Type: Journal Article
• Authors: Chotsiri, Palang; White, Nicholas J.; Tarning, Joel
• Is Part Of: Trends in parasitology. Volume 38:Issue 8(2022)
• Page Start: 673
• Page End: 682
• Publication Date: 2022-08
• Subjects: seasonal malaria chemoprevention -- children -- pharmacokinetics -- sulfadoxine-pyrimethamine -- amodiaquine -- dihydroartemisinin-piperaquine; Parasitology -- Periodicals; Parasitology -- Periodicals; Biology -- Periodicals; Parasitology; Biology; Parasitologie -- Périodiques; Online resources; 571.999
• DOI: 10.1016/j.pt.2022.05.003
• Languages: English
• ISSNs: 1471-4922

Abstract

Abstract : African children under 5 years of age bear the main burden of global malaria mortality. Seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ) given monthly during the rainy season is a highly effective malaria intervention for children aged between 3 months and 5 years living in the Sahel region, a region of intense but seasonal malaria transmission. This intervention is now being considered for other regions of Africa where malaria parasites are more drug resistant. Dihydroartemisinin-piperaquine (DP), an artemisinin-based combination therapy (ACT), has proved to be highly effective and well tolerated in intermittent preventive treatment in pregnant women and children. This combination may be a suitable alternative for SMC. Understanding the safety, pharmacokinetic and pharmacodynamic properties of antimalarial combination therapies is crucial in optimising dosing. Highlights: In the Sahel region, more than 60% of the annual cases of malaria occur during the rainy season (approximately 3–4 months). Children under 5 years of age are the population most vulnerable to malaria infections and they are the recipients of seasonal malaria chemoprevention (SMC). Sulfadoxine-pyrimethamine plus amodiaquine comprise the only World Health Organization (WHO) recommended SMC, but increasing drug resistance threatens its future. Expanding the deployment of SMC to East and South-East Africa is under evaluation. This region has higher levels of drug resistance than the Sahel. Alternative SMCs are needed. A better understanding of the safety, pharmacokinetic and pharmacodynamic properties of potential SMC medicines, and the determinants of preventive efficacy, should guide the choice of drugs, dosing, and dosing intervals.