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Azithromycin plus chloroquine: combination therapy for protection against malaria and sexually transmitted infections in pregnancy

INTRODUCTION: The first-line therapy for the intermittent preventive treatment of malaria in pregnancy (IPTp) is sulphadoxine-pyrimethamine (SP). There is an urgent need to identify safe, well-tolerated and efficacious alternatives to SP due to widespread Plasmodium falciparum resistance. Combinatio...

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Autores principales: Chico, R Matthew, Chandramohan, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Informa Healthcare 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170143/
https://www.ncbi.nlm.nih.gov/pubmed/21736423
http://dx.doi.org/10.1517/17425255.2011.598506
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author Chico, R Matthew
Chandramohan, Daniel
author_facet Chico, R Matthew
Chandramohan, Daniel
author_sort Chico, R Matthew
collection PubMed
description INTRODUCTION: The first-line therapy for the intermittent preventive treatment of malaria in pregnancy (IPTp) is sulphadoxine-pyrimethamine (SP). There is an urgent need to identify safe, well-tolerated and efficacious alternatives to SP due to widespread Plasmodium falciparum resistance. Combination therapy using azithromycin and chloroquine is one possibility that has demonstrated adequate parasitological response > 95% in clinical trials of non-pregnant adults in sub-Saharan Africa and where IPTp is a government policy in 33 countries. AREAS COVERED: Key safety, tolerability and efficacy data are presented for azithromycin and chloroquine, alone and/or in combination, when used to prevent and/or treat P. falciparum, P. vivax, and several curable sexually transmitted and reproductive tract infections (STI/RTI). Pharmacokinetic evidence from pregnant women is also summarized for both compounds. EXPERT OPINION: The azithromycin-chloroquine regimen that has demonstrated consistent efficacy in non-pregnant adults has been a 3-day course containing daily doses of 1 g of azithromycin and 600 mg base of chloroquine. The pharmacokinetic evidence of these compounds individually suggests that dose adjustments may not be necessary when used in combination for treatment efficacy against P. falciparum, P. vivax, as well as several curable STI/ RTI among pregnant women, although clinical confirmation will be necessary. Mass trachoma-treatment campaigns have shown that azithromycin selects for macrolide resistance in the pneumococcus, which reverses following the completion of therapy. Most importantly, no evidence to date suggests that azithromycin induces pneumococcal resistance to penicillin.
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spelling pubmed-31701432011-09-28 Azithromycin plus chloroquine: combination therapy for protection against malaria and sexually transmitted infections in pregnancy Chico, R Matthew Chandramohan, Daniel Expert Opin Drug Metab Toxicol Drug Evaluation INTRODUCTION: The first-line therapy for the intermittent preventive treatment of malaria in pregnancy (IPTp) is sulphadoxine-pyrimethamine (SP). There is an urgent need to identify safe, well-tolerated and efficacious alternatives to SP due to widespread Plasmodium falciparum resistance. Combination therapy using azithromycin and chloroquine is one possibility that has demonstrated adequate parasitological response > 95% in clinical trials of non-pregnant adults in sub-Saharan Africa and where IPTp is a government policy in 33 countries. AREAS COVERED: Key safety, tolerability and efficacy data are presented for azithromycin and chloroquine, alone and/or in combination, when used to prevent and/or treat P. falciparum, P. vivax, and several curable sexually transmitted and reproductive tract infections (STI/RTI). Pharmacokinetic evidence from pregnant women is also summarized for both compounds. EXPERT OPINION: The azithromycin-chloroquine regimen that has demonstrated consistent efficacy in non-pregnant adults has been a 3-day course containing daily doses of 1 g of azithromycin and 600 mg base of chloroquine. The pharmacokinetic evidence of these compounds individually suggests that dose adjustments may not be necessary when used in combination for treatment efficacy against P. falciparum, P. vivax, as well as several curable STI/ RTI among pregnant women, although clinical confirmation will be necessary. Mass trachoma-treatment campaigns have shown that azithromycin selects for macrolide resistance in the pneumococcus, which reverses following the completion of therapy. Most importantly, no evidence to date suggests that azithromycin induces pneumococcal resistance to penicillin. Informa Healthcare 2011-09 2011-07-07 /pmc/articles/PMC3170143/ /pubmed/21736423 http://dx.doi.org/10.1517/17425255.2011.598506 Text en © 2011 Informa UK, Ltd http://creativecommons.org/licenses/by/2.0/ This is an open access article distributed under the Supplemental Terms and Conditions for iOpenAccess articles published in Informa Healthcare journals (http://www.informaworld.com/mpp/uploads/iopenaccess_tcs.pdf) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Drug Evaluation
Chico, R Matthew
Chandramohan, Daniel
Azithromycin plus chloroquine: combination therapy for protection against malaria and sexually transmitted infections in pregnancy
title Azithromycin plus chloroquine: combination therapy for protection against malaria and sexually transmitted infections in pregnancy
title_full Azithromycin plus chloroquine: combination therapy for protection against malaria and sexually transmitted infections in pregnancy
title_fullStr Azithromycin plus chloroquine: combination therapy for protection against malaria and sexually transmitted infections in pregnancy
title_full_unstemmed Azithromycin plus chloroquine: combination therapy for protection against malaria and sexually transmitted infections in pregnancy
title_short Azithromycin plus chloroquine: combination therapy for protection against malaria and sexually transmitted infections in pregnancy
title_sort azithromycin plus chloroquine: combination therapy for protection against malaria and sexually transmitted infections in pregnancy
topic Drug Evaluation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170143/
https://www.ncbi.nlm.nih.gov/pubmed/21736423
http://dx.doi.org/10.1517/17425255.2011.598506
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