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. (25th February 2015)

• Record Type: Journal Article
• Authors: Capan-Melser, Mesküre; Mombo Ngoma, Ghyslain; Akerey-Diop, Daisy; Basra, Arti; Würbel, Heike; Groger, Mirjam; Mackanga, Jean R.; Zoleko-Manego, Rella; Schipulle, Ulla; Schwing, Julia; Lötsch, Felix; Rehman, Khalid; Matsiegui, Pierre-Blaise; Agnandji, Selidji T.; Adegnika, Ayôla A.; Bélard, Sabine; González, Raquel; Kremsner, Peter G.; Menendez, Clara; Ramharter, Michael
• Is Part Of: Journal of antimicrobial chemotherapy. Volume 70:Number 6(2015:Jun.)
• Page Start: 1898
• Page End: 1902
• Publication Date: 2015-02-25
• Subjects: Streptococcus agalactiae -- maternal GBS colonization -- intermittent preventive treatment in pregnancy -- sub-Saharan Africa; Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; 615.58
• DOI: 10.1093/jac/dkv041
• Languages: English
• ISSNs: 0305-7453

Abstract

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.