Plasma folate level and high-dose folate supplementation predict sulfadoxine-pyrimethamine treatment failure in pregnant women in Western kenya who have uncomplicated malaria.
Sulfadoxine-pyrimethamine (SP) inhibits folate metabolism by the malaria parasite. We investigated the association between folate levels and SP failure in pregnant women. Data from a trial to assess the effect that folate supplementation has on SP failure in 467 pregnant women were analyzed. Plasma folate levels were determined at enrollment and at day 7. High baseline folate levels, high parasite densities, and age <20 years were risk factors for SP failure. High-dose (5 mg daily) folate supplementation or high folate levels at day 7 were independent risk factors. Therefore, pregnant women receiving SP should receive low-/moderate-dose folate supplementation.


BACKGROUND
http://www.clinicaltrials.gov identifier: NCT00130065.
van Eijk
Anna M
AM
Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. amvaneijk@yahoo.com
Ouma
Peter O
PO
Williamson
John
J
Ter Kuile
Feiko O
FO
Parise
Monica
M
Otieno
Kephas
K
Hamel
Mary J
MJ
Ayisi
John G
JG
Kariuki
Simon
S
Kager
Piet A
PA
Slutsker
Laurence
L
D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D019587:Dietary Supplements; D004338:Drug Combinations; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage* / Q000097:blood*; D006801:Humans; D007630:Kenya; D008288:Malaria / Q000188:drug therapy*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy*; D011739:Pyrimethamine / Q000627:therapeutic use*; D012307:Risk Factors; D013413:Sulfadoxine / Q000627:therapeutic use*; D016019:Survival Analysis; D017211:Treatment Failure; D055815:Young Adult
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D005492:Folic Acid; D011739:Pyrimethamine