Azithromycin does not reduce malaria, STI risk for pregnant women at delivery
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Key takeaways:
- Giving pregnant women azithromycin did not reduce malaria or STI incidence at delivery compared with standard treatment.
- Incidences of adverse birth outcomes were lower in the treatment group.
The addition of azithromycin to daily trimethoprim-sulfamethoxazole treatment among pregnant women with HIV did not reduce the rate of malaria or bacterial STIs at delivery, data show.
“Malaria and bacterial sexually transmitted infections, including chlamydia, gonorrhea and syphilis, are among the most common infections diagnosed during pregnancy in Africa and a common cause of adverse pregnancy outcomes for women and infants,” Jodie A. Dionne, MD, MSPH, associate professor of medicine and of obstetrics and gynecology, and director of the Infection in Women and Pregnancy Research Program at the University of Alabama at Birmingham, told Healio.
To test the effectiveness of a novel regimen to prevent malaria and STIs among pregnant women with HIV in Cameroon, Dionne and colleagues assessed the addition of azithromycin to standard daily trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis. Pregnant women with HIV who were at gestational age earlier than 28 weeks were randomized to adjunctive monthly oral azithromycin at 1g per day or placebo for 3 days in addition to oral TMP-SMX through delivery. Primary study outcomes included positive malaria infection or bacterial genital STI at delivery.
In total, 308 pregnant women with HIV, all of whom were on ART, were enrolled in the study between March 2018 and August 2020. Of these women, 155 were randomized to receive TMP-SMX with azithromycin and 153 to receive TMP-SMX with placebo.
The researchers noted that daily ART adherence was 96.8% among women receiving TMP-SMX with azithromycin and 91.4% among those given TMP-SMX with placebo, while daily TMP-SMX adherence was 89.3% in the azithromycin group vs. 77% in the placebo group.
Overall, Dionne and colleagues reported no difference in the proportion of women with malaria (16.3% in TMP-SMX-azithromycin vs. 13.2% in TMP-SMX-placebo; relative risk [RR] = 1.24; 95% CI, 0.71-2.16) or STI (4.2% in TMP-SMX-azithromycin vs. 5.8% in TMP-SMX-placebo; RR = 0.72; 95% CI, 0.26-2.03) at delivery.
Adverse birth outcomes also were not significantly different, though they were lower among infants in the azithromycin group. Specifically, treatment with azithromycin saw lower rates of preterm delivery (6.7% vs. 10.7) and low birth weight (3.4% vs. 5.4%).
“The question about how improve the prevention of malaria and STIs in pregnancy in endemic regions remains a compelling question,” Dionne said. “Newer studies of novel treatments and vaccines for malaria and STIs with safety and efficacy must be designed to include pregnant women and people of reproductive age in Africa where the burden of disease remains high.”
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