Evaluation of intermittent preventive treatment of malaria against group B Streptococcus colonization in pregnant women: a nested analysis of a randomized controlled clinical trial of sulfadoxine/pyrimethamine versus mefloquine.
OBJECTIVE
Streptococcus agalactiae constitutes an important cause of neonatal infections in sub-Saharan Africa. Sulfadoxine/pyrimethamine-the current intermittent preventive treatment of malaria in pregnancy (IPTp)-has proven in vitro activity against group B Streptococcus (GBS). Because of specific drug resistance to sulfadoxine/pyrimethamine, mefloquine-an antimalarial without in vitro activity against GBS-was evaluated as a potential alternative. This study assessed the potential of sulfadoxine/pyrimethamine-IPTp to reduce the prevalence of GBS colonization in pregnant women in Gabon when compared with the inactive control mefloquine-IPTp.


METHODS
Pregnant women participating in a randomized controlled clinical trial evaluating mefloquine-IPTp versus sulfadoxine/pyrimethamine-IPTp were invited to participate and recto-vaginal swabs were collected at delivery for detection of GBS colonization. Prevalence of recto-vaginal GBS colonization was compared between IPTp regimens and risk factor and birth outcome analyses were computed.


RESULTS
Among 549 participants, 106 were positive for GBS colonization at delivery (19%; 95% CI = 16%-23%). Prevalence of maternal GBS colonization showed no significant difference between the two IPTp regimens (mefloquine-IPTp: 67 of 366 women = 18%; 95% CI = 14%-22%; sulfadoxine/pyrimethamine-IPTp: 39 of 183 women = 21%; 95% CI = 15%-27%). Risk factor analysis for GBS colonization demonstrated a significant association with illiteracy (adjusted OR = 2.03; 95% CI = 1.25-3.30). GBS colonization had no impact on birth outcome, anaemia at delivery, gestational age and birth weight.


CONCLUSIONS
Sulfadoxine/pyrimethamine did not reduce colonization rates when used as the IPTp drug during pregnancy. Illiteracy was associated with GBS colonization.
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
Mesküre
M
Capan-Melser
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany Département de Parasitologie, Université des Sciences de la Santé, Libreville, Gabon.
Ghyslain
G
Mombo Ngoma
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
Daisy
D
Akerey-Diop
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
Arti
A
Basra
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
Heike
H
Würbel
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
Mirjam
M
Groger
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
Jean R
JR
Mackanga
Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany Ngounie Medical Research Centre, Fougamou, Gabon.
Rella
R
Zoleko-Manego
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
Ulla
U
Schipulle
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
Julia
J
Schwing
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
Felix
F
Lötsch
Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
Khalid
K
Rehman
Ngounie Medical Research Centre, Fougamou, Gabon.
Pierre-Blaise
PB
Matsiegui
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
Selidji T
ST
Agnandji
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
Ayôla A
AA
Adegnika
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Sabine
S
Bélard
Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), IS Global, Barcelona, Spain.
Raquel
R
González
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
Peter G
PG
Kremsner
Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), IS Global, Barcelona, Spain.
Clara
C
Menendez
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria michael.ramharter@meduniwien.ac.at.
Michael
M
Ramharter
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000962:Antimalarials / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D005681:Gabon; D006801:Humans; D008288:Malaria / Q000517:prevention & control; D015767:Mefloquine / Q000008:administration & dosage*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011739:Pyrimethamine / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D012007:Rectum / Q000382:microbiology; D013290:Streptococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000302:isolation & purification*; D013413:Sulfadoxine / Q000008:administration & dosage*; D014621:Vagina / Q000382:microbiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D015767:Mefloquine; D011739:Pyrimethamine
Streptococcus agalactiae; intermittent preventive treatment in pregnancy; maternal GBS colonization; sub-Saharan Africa