Abstract:
Background. The use of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy
(IPTp) is threatened by the spread of resistance to SP. Therefore, we studied the efficacy, safety, and tolerance of
amodiaquine (AQ) or the combination of AQ and SP (SPAQ) as possible alternative treatments.
Methods. The study was performed in Ghana from June 2004 through February 2007. Women were individually
randomized to receive IPTp with SP (n ⫽ 1328), AQ (n ⫽ 986), or SPAQ (n ⫽ 1328). Incidences of anemia, pe-
ripheral anemia, and placental parasitemia at delivery were assessed for paucigravidae, as were the birth weights of
their infants. Delivery outcomes and the incidence of adverse events were investigated for all women.
Results. The prevalences of anemia (as defined by a hemoglobin concentration of ⬍11.0 g/dL) at delivery were
comparable between the SP and AQ groups and between the SP and SPAQ groups. Similarly, there was no significant
difference between the SP and AQ groups or between the SP and SPAQ groups with regard to the incidences of low
birth weight (LBW). Women who received AQ or SPAQ were more likely to report adverse events than were those who
received SP.
Conclusion. The effects of IPTp with AQ or SPAQ on maternal anemia and LBW were comparable to the effects
of IPTp with SP; however, IPTp regimens that contain AQ are unlikely to be useful as an alternative to IPTp with SP
in Ghana, because of a high frequency of associated adverse events.
