A community-randomised evaluation of the effect of IPTi on anti-malarial drug resistance in southern Tanzania.


Pearce, RJ; Ord, R; Kaur, H; Lupala, C; Schellenberg, J; Shirima, K; Manzi, F; Alonso, P; Tanner, M; Mshinda, H; Roper, C; Schellenberg, D; (2013) A community-randomised evaluation of the effect of IPTi on anti-malarial drug resistance in southern Tanzania. The Journal of infectious diseases, 207 (5). pp. 848-59. ISSN 0022-1899 DOI: 10.1093/infdis/jis742

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Abstract

BACKGROUND: Intermittent preventive treatment in infants (IPTi) is the administration of sulfadoxine-pyrimethamine (SP) at 2, 3, and 9 months of age to prevent malaria. We investigated the influence of IPTi on drug resistance.<br/> METHODS: Twenty-four areas were randomly assigned to receive or not receive IPTi. Blood collected during representative household surveys at baseline and 15 and 27 months after implementation was tested for SP and resistance markers.<br/> RESULTS: The frequency of SP in blood was similar in the IPTi and comparison areas at baseline and at 15 months. dhfr and dhps mutations were also similar at baseline and then increased similarly in both arms after 15 months of SP-IPTi. First-line treatment was switched from SP to artemether-lumefantrine before the final survey, when SP positivity fell among infants in comparison areas but increased in IPTi areas. This was accompanied by an increase in dhfr but not dhps mutations in IPTi areas (P = .004 and P = .18, respectively).<br/> CONCLUSIONS: IPTi did not increase drug pressure or the selection on dhfr and dhps mutants, when SP was the first-line malaria treatment. Introduction of artemether-lumefantrine was followed by an increase in dhfr mutations, consistent with weak selection attributable to SP-IPTi, but not by an increase in dhps mutations, suggesting a fitness cost of this mutation.<br/>

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Pathogen Molecular Biology
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Research Centre: Antimicrobial Resistance Centre (AMR)
Malaria Centre
Centre for Evaluation
Tropical Epidemiology Group
PubMed ID: 23225897
Web of Science ID: 314894600019
URI: http://researchonline.lshtm.ac.uk/id/eprint/512759

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