title: Azithromycin plus chloroquine: combination therapy for protection against malaria and sexually transmitted infections in pregnancy.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, Disease Control Department, UK. Matthew.Chico@lshtm.ac.uk
authors: R Matthew
authors: RM
authors: Chico
authors: Daniel
authors: D
authors: Chandramohan
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D000962:Antimalarials / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D017963:Azithromycin / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D002738:Chloroquine / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000517:prevention & control; D012749:Sexually Transmitted Diseases / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials; D017963:Azithromycin; D002738:Chloroquine