Active substance: Azithromycin
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IPTp has two primary objectives: 1 to clear asymptomatic peripheral and placental parasitaemia and 2 to provide intermittent chemoprophylaxis against malaria infection during pregnancy. An estimated 7. Among HIV-negative women.
In many countries, artemisinin combination therapy ACT has replaced SP for case management, according to WHO guidelines, because SP now demonstrates inadequate therapeutic efficacy in children.
Therapeutic efficacy of SP in children with clinical cases of P. This protection, however, is not uniform across populations; primigravidae are particularly vulnerable to the effects of MIP and are protected the least by SP where sensitivity is on the decline.
In Ghana, where parasite sensitivity to SP remains higher than in east and southern Africa, uncorrected parasitological failure rates by day 28 post-treatment were 36.
Thus, SP is already compromised and an urgent need exists to identify alternative compounds for use in IPTp, even though SP still offers some protection up to an unknown threshold of parasite resistance. An ideal anti-malarial drug or drug combination for IPTp should be safe, well tolerated, efficacious in the clearance of malaria parasites, provide a long period of chemoprotection and, preferably, not be deployed as the first-line treatment for clinical malaria.
This is particularly important as countries increasingly treat pregnant women with uncomplicated clinical malaria in second- and third-trimesters with ACTs.
Several published reviews of drugs for IPTp have included azithromycin and chloroquine, although only as monotherapies.
This review summarizes in vitro and in vivo evidence for the therapeutic efficacy of azithromycin and chloroquine when used alone or together and discusses the additional benefits that the combination could have on many sexually transmitted diseases and, possibly, pneumococcal infection during pregnancy.
Drug costs are presented along with issues related to drug resistance and surveillance. Several scientific and programmatic areas are outlined, as well, that would need to be addressed for policymakers and programme managers before azithromycin-chloroquine could be adopted for use in IPTp.
Azithromycin monotherapy for treatment and prevention of malaria Pharmacokinetics Azithromycin is a slow-acting anti-malarial macrolide, an analogue of erythromycin with a nitrogen atom inserted into the macrolide nucleus.
As a result, there is enhanced penetration of drug into macrophages, fibroblasts and polymorphonuclear neutrophils, permitting greater accumulation within acidified vacuoles and extending the 1.
It accumulates in hepatic, renal, pulmonary and splenic tissue, and gradually leaches into the bloodstream over a period of one week.
Mild renal dysfunction and mild-to-moderate hepatic dysfunction do not affect excretion significantly.
As the drug disperses, peak concentrations are maintained three-times longer in the placenta, myometrial and adipose tissues ; only 2.
Azithromycin is excreted in human milk with no adverse events observed as a consequence. Azithromycin targets the 70 S ribosomal subunit of the apical complex of susceptible micro-organisms including P.
Once attached to the apicoplasts of the parasite, azithromycin hinders polypeptide development, triggering premature detachment and movement down the peptide exit tunnel.
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