title: Efficacy of mefloquine intermittent preventive treatment in pregnancy against Schistosoma haematobium infection in Gabon: a nested randomized controlled assessor-blinded clinical trial.
abstract: BACKGROUND
  Urogenital schistosomiasis is a major public health problem in sub-Saharan Africa, and routine programs for screening and treatment of pregnant women are not established. Mefloquine-currently evaluated as a potential alternative to sulfadoxine-pyrimethamine as intermittent preventive treatment against malaria in pregnancy (IPTp)-is known to exhibit activity against Schistosoma haematobium. In this study we evaluated the efficacy of mefloquine IPTp against S. haematobium infection in pregnant women.
  
  
  METHODS
  Pregnant women with S. haematobium infection presenting at 2 antenatal health care centers in rural Gabon were invited to participate in this nested randomized controlled, assessor-blinded clinical trial comparing sulfadoxine-pyrimethamine with mefloquine IPTp. Study drugs were administered twice during pregnancy with a 1- month interval after completion of the first trimester.
  
  
  RESULTS
  Sixty-five pregnant women were included in this study. Schistosoma haematobium egg excretion rates showed a median reduction of 98% (interquartile range [IQR], 70%-100%) in the mefloquine group compared to an increase of 20% (IQR, -186% to 75%) in the comparator group. More than 80% of patients showed at least 50% reduction of egg excretion and overall cure rate was 47% (IQR, 36%-70%) 6 weeks after the second administration of mefloquine IPTp.
  
  
  CONCLUSIONS
  When used as IPTp for the prevention of malaria, mefloquine shows promising activity against concomitant S. haematobium infection leading to an important reduction of egg excretion in pregnant women. Provided that further studies confirm these findings, the use of mefloquine may transform future IPTp programs into a 2-pronged intervention addressing 2 of the most virulent parasitic infections in pregnant women in sub-Saharan Africa.
  
  
  BACKGROUND
  NCT01132248; ATMR2010020001429343.
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Université des Sciences de la Santé, Libreville, Gabon.
authors.forename: Arti
authors.initials: A
authors.lastname: Basra
authors.forename: Ghyslain
authors.initials: G
authors.lastname: Mombo-Ngoma
authors.forename: Meskure Capan
authors.initials: MC
authors.lastname: Melser
authors.forename: Daisy Akerey
authors.initials: DA
authors.lastname: Diop
authors.forename: Heike
authors.initials: H
authors.lastname: Würbel
authors.forename: Jean-Rodolphe
authors.initials: JR
authors.lastname: Mackanga
authors.forename: Moritz
authors.initials: M
authors.lastname: Fürstenau
authors.forename: Rella Manego
authors.initials: RM
authors.lastname: Zoleko
authors.forename: Ayola A
authors.initials: AA
authors.lastname: Adegnika
authors.forename: Raquel
authors.initials: R
authors.lastname: Gonzalez
authors.forename: Clara
authors.initials: C
authors.lastname: Menendez
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kremsner
authors.forename: Michael
authors.initials: M
authors.lastname: Ramharter
mesh_terms: D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods*; D004338:Drug Combinations; D005243:Feces / Q000469:parasitology; D005260:Female; D005681:Gabon; D006801:Humans; D015767:Mefloquine / Q000008:administration & dosage*; D010270:Parasite Egg Count; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011739:Pyrimethamine / Q000008:administration & dosage; D012424:Rural Population; D012548:Schistosoma haematobium / Q000302:isolation & purification; D012553:Schistosomiasis haematobia / Q000517:prevention & control*; D016037:Single-Blind Method; D013413:Sulfadoxine / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D015767:Mefloquine; D011739:Pyrimethamine