| Summary: | <p>Abstract</p> <p>Background</p> <p>Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine (SP) is recommended for the prevention of malaria in pregnancy in sub-Saharan Africa. Increasing drug resistance necessitates the urgent evaluation of alternative drugs. Currently, the most promising candidates in clinical development are mefloquine and azithromycin. Besides the anti-malarial activity, SP is also a potent antibiotic and incurs significant anti-microbial activity when given as IPTp - though systematic clinical evaluation of this action is still lacking.</p> <p>Methods</p> <p>In this study, the intrinsic anti-bacterial activity of mefloquine and azithromycin was assessed in comparison to sulphadoxine-pyrimethamine against bacterial pathogens with clinical importance in pregnancy in a standard microdilution assay.</p> <p>Results</p> <p>SP was highly active against <it>Staphylococcus aureus </it>and <it>Streptococcus pneumoniae</it>. All tested Gram-positive bacteria, except <it>Enterococcus faecalis</it>, were sensitive to azithromycin. Additionally, azithromycin was active against <it>Neisseria gonorrhoeae</it>. Mefloquine showed good activity against pneumococci but lower <it>in vitro </it>action against all other tested pathogens.</p> <p>Conclusion</p> <p>These data indicate important differences in the spectrum of anti-bacterial activity for the evaluated anti-malarial drugs. Given the large scale use of IPTp in Africa, the need for prospective clinical trials evaluating the impact of antibiotic activity of anti-malarials on maternal and foetal health and on the risk of promoting specific drug resistance of bacterial pathogens is discussed.</p>
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