Format

Send to

Choose Destination
Malar J. 2018 Dec 14;17(1):469. doi: 10.1186/s12936-018-2621-x.

Has doxycycline, in combination with anti-malarial drugs, a role to play in intermittent preventive treatment of Plasmodium falciparum malaria infection in pregnant women in Africa?

Author information

1
Fédération des Laboratoires, Hôpital d'Instruction des Armées Desgenettes, Lyon, France.
2
Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.
3
Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, IHU Méditerranée Infection, Marseille, France.
4
Centre National de Référence du Paludisme, Institut de Recherche Biomédicale des Armées, Marseille, France.
5
Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 19-21 Boulevard Jean Moulin, 13005, Marseille, France. bruno.pradines@gmail.com.
6
Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, IHU Méditerranée Infection, Marseille, France. bruno.pradines@gmail.com.
7
Centre National de Référence du Paludisme, Institut de Recherche Biomédicale des Armées, Marseille, France. bruno.pradines@gmail.com.

Abstract

According to the World Health Organization (WHO), Plasmodium falciparum malaria during pregnancy is responsible for deleterious consequences for the mother and her child. The administration of intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) at each antenatal care visit as early as 13 weeks of gestation until the time of delivery is a strategy that is currently recommended by WHO for the prevention of malaria in pregnancy. However, the emergence and the spread of the resistance to SP in Africa raise the question of the short-term effectiveness of the strategy. Dihydroartemisinin-piperaquine 120 mg/960 mg once a day for 3 consecutive days administered at least three times during the pregnancy might be an option for IPTp. The combination of 200 mg of doxycycline once a day for 3 consecutive days seems to be a good option to retard the emergence and the spread of resistance to artemisinin-based combination therapy (ACT) in Africa and improve the effectiveness of ACT in term of preterm births, neonatal morbidity and mortality. Contrary to preconceived ideas, scientific and medical data suggest that the risk of congenital malformations in the fetus or of tooth staining in infants whose mothers take doxycycline and hepatotoxicity during pregnancy is very low or non-existent. Additionally, the use of doxycycline during the first and second trimesters leads to an increase in gestational age at delivery, a decrease in the number of preterm births and a reduction in neonatal morbidity and mortality due to the beneficial antimicrobial activity of doxycycline against other infections during pregnancy. Furthermore, doxycycline has anti-malarial properties and is already recommended as prophylaxis for travellers and for treatment of falciparum malaria in combination with other anti-malarial drugs.

KEYWORDS:

Anti-malarial drug; Antibiotics; Doxycycline; Intermittent Preventive Treatment; Malaria; Plasmodium falciparum; Pregnancy; Resistance

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center