Intermittent Preventive Antimalarial Treatment in Infants

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Abstract
Intermittent preventive antimalarial treatment in infants (IPTi) involves the administration of a curative dose of an antimalarial drug to infants at the time of routine immunization, without determining whether the infant is parasitemic. This approach to the prevention of malaria in infants was tried first by Schellenberg et al. [1] in Ifakara, Tanzania, in 1999. They found that administration of sulfadoxine-pyrimethamine (SP) to infants when they presented for vaccination with diphtheria, pertussis, and tetanus or measles vaccines at 2, 3, and 9 months of age reduced the incidence of clinical attacks of malaria and anemia (packed cell volume, <25%) by 59% (95% CI, 41%–72%) and 50% (95% CI, 8%–73%), respectively. Remarkably, protection persisted throughout the second year of life, long after SP had disappeared from circulation [2]. A second trial conducted in Tanzania at approximately the same time found that administration of amodiaquine to infants at 3-month intervals during the first year of life had a similar impact on the incidence of clinical attacks of malaria and anemia [3]. These very promising results led to the creation of the IPTi Consortium [4], whose brief is to determine the efficacy, safety, relation of efficacy to drug sensitivity, cost-effectiveness, and acceptability of this promising new approach to the prevention of malaria.