Treatment with sulfadoxine-pyrimethamine plus azithromycin prevents childhood stunting
Receipt of monthly sulfadoxine-pyrimethamine with two doses of azithromycin (AZI-SP) during pregnancy is more effective than receipt of two doses of sulfadoxine-pyrimethamine (SP) alone in terms of reducing the incidence of stunting in childhood, according to a study. Additionally, AZI-SP during pregnancy exerts a positive effect on child development and appears to reduce postneonatal mortality.
In the study, a total of 1,320 pregnant Malawian women were treated for malaria and other infections with one of the following: two doses of SP (control), monthly SP or AZI-SP. Child height or length and mortality were evaluated at 1, 6, 12, 24, 36, 48 and 60 months, while development was assessed at 60 months using Griffith’s Mental Development Scales.
Compared with the control group, the AZI-SP group showed higher mean child length (0.4–0.7 cm higher at 1–12 months; p<0.05), lower prevalence of stunting (6–11 percentage points lower at 12–36 months; p<0.05) and reduced 5-year cumulative incidence of stunting (13 percentage points lower; hazard ratio, 0.70; 95 percent CI, 0.60–0.83; p<0.001).
Moreover, the mean developmental score was 3.8 points higher in the AZI-SP group vs control group (p=0.005).
Total mortality during pregnancy and childhood was comparable across the treatment groups: 15.3 percent in the control group, 15.1 percent in the monthly SP group and 13.1 percent in the AZI-SP group (p=0.60). Postneonatal mortality rates were 5.5 percent, 3.3 percent and 1.9 percent, respectively (AZI-SP vs control: risk ratio, 0.34; 0.15–0.76; p=0.008).
The present data indicate that the provision of AZI-SP rather than two doses of SP during pregnancy reduces the incidence and prevalence of childhood stunting, has a positive effect on child development, and may reduce postneonatal mortality in Malawi.
However, researchers warned that the results, although encouraging, should not be interpreted to promote widespread use of broad-spectrum antibiotics as a routine antenatal treatment. Such practice could potentially result in antibiotic resistance and cause detrimental long-term effects on the microbiota of both the mother and her offspring.