Context: The benefit of malaria prophylaxis in pregnancy is threatened by emergence of Plasmodium falciparum resistance to antimalarial agents for chemoprophylaxis and treatment.
Aim: This study aimed to compare the effectiveness of azithromycin (AZ) with sulphadoxine-pyrimethamine (SP) for malaria prevention.
Settings and Design: A prospective comparative study of antenatal clinic attendees at the University College Hospital, Ibadan, Nigeria. Participants were randomised to receive SP or AZ.
Subjects and Methods: The subjects were antenatal attendees and Samples for malaria parasitaemia were collected and repeated at follow-up visits; maternal peripheral blood film, placental and cord blood samples were collected at delivery.
Statistical Analysis Used: Chi-square test and t-test in a per-protocol analysis.
Results: Of 200 participants (100 in each group), 166 (83.0%) completed the study: 86 (86.0%) of SP and 80 (80.0%) of AZ groups, respectively (P = 0.26). Four (4.7%) participants who had SP compared to five (6.2%) in AZ group developed malaria at mean gestational ages of 30.3 ± 1.56 and 33.0 ± 8.6, respectively (P = 0.56). Positive peripheral, placental and cord blood parasitaemia were found in ≤2% of the participants. Drug tolerability and foetal outcomes were comparable for both groups.
Conclusion: AZ was comparable to SP for prevention of malaria in pregnancy and may be used in patients who do not tolerate SP.