Safety and Efficacy of Co-Trimoxazole for Treatment and Prevention of Plasmodium falciparum Malaria: A Systematic Review

Abstract

IntroductionCotrimoxazole (CTX) has been used for half a century. It is inexpensive hence the reason for its almost universal availability and wide clinical spectrum of use. In the last decade, CTX was used for prophylaxis of opportunistic infections in HIV infected people. It also had an impact on the malaria risk in this specific group.ObjectiveWe performed a systematic review to explore the efficacy and safety of CTX used for P.falciparum malaria treatment and prophylaxis.ResultCTX is safe and efficacious against malaria. Up to 75% of the safety concerns relate to skin reactions and this increases in HIV/AIDs patients. In different study areas, in HIV negative individuals, CTX used as malaria treatment cleared 56%–97% of the malaria infections, reduced fever and improved anaemia. CTX prophylaxis reduces the incidence of clinical malaria in HIV-1 infected individuals from 46%–97%. In HIV negative non pregnant participants, CTX prophylaxis had 39.5%–99.5% protective efficacy against clinical malaria. The lowest figures were observed in zones of high sulfadoxine-pyrimethamine resistance. There were no data reported on CTX prophylaxis in HIV negative pregnant women.ConclusionCTX is safe and still efficacious for the treatment of P.falciparum malaria in non-pregnant adults and children irrespective of HIV status and antifolate resistance profiles. There is need to explore its effect in pregnant women, irrespective of HIV status. CTX prophylaxis in HIV infected individuals protects against malaria and CTX may have a role for malaria prophylaxis in specific HIV negative target groups.

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

“…Daily co‐trimoxazole prophylaxis may also be considered for children travelling to countries with a high prevalence of bacterial infections and/or malaria, irrespective of their CD4 count/percentage and current treatment status 6, 24, 30, 31. The use of co‐trimoxazole in this context may also have additional benefit as antimalarial prophylaxis 32, although specific malaria prophylaxis appropriate to the regions being visited should always be prescribed.…”

Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa

“…A cross-sectional analysis of observational data in Malawi found that daily CTX was associated with reduced malaria parasitaemia and anaemia compared to IPTp-SP among HIV-positive pregnant women [19]. However, while CTX was found to be effective in preventing clinical malaria [20,21], long-term efficacy relative to standard IPTp-SP, toxicity, and birth outcomes associated with CTX have not been established in trials [22]. Many national guidelines still recommend a mix of IPTp-SP and CTX because of past WHO guidelines that recommended IPTp-SP, and because imperfect adherence to daily CTX may put women at risk compared with only 3 doses of IPTp-SP [23].…”

Insights Into Circulating Cytokine Dynamics During Pregnancy in HIV-Infected Beninese Exposed to Plasmodium falciparum Malaria

“…15,20 Not unexpectedly, our study shows that the presence of infection with P. falciparum at inclusion is associated with the low CD4 + T cell counts, themselves primarily related to the concurrent HIV infection, as well with the absence of any previous anti-malarial preventive treatment (IPTp), both of which lead to a stronger likelihood that pregnant women have plasmodial infections (Tables 1-3). Nevertheless, it should be stressed in this context that our sample size is small, and that some of our data only revealed trends that show borderline significance.…”