Evaluation of intermittent preventive treatment of malaria against group B Streptococcus colonization in pregnant women: a nested analysis of a randomized controlled clinical trial of sulfadoxine/pyrimethamine versus mefloquine

J Antimicrob Chemother. 2015;70(6):1898-902. doi: 10.1093/jac/dkv041. Epub 2015 Feb 25.


Objectives: Streptococcus agalactiae constitutes an important cause of neonatal infections in sub-Saharan Africa. Sulfadoxine/pyrimethamine-the current intermittent preventive treatment of malaria in pregnancy (IPTp)-has proven in vitro activity against group B Streptococcus (GBS). Because of specific drug resistance to sulfadoxine/pyrimethamine, mefloquine-an antimalarial without in vitro activity against GBS-was evaluated as a potential alternative. This study assessed the potential of sulfadoxine/pyrimethamine-IPTp to reduce the prevalence of GBS colonization in pregnant women in Gabon when compared with the inactive control mefloquine-IPTp.

Methods: Pregnant women participating in a randomized controlled clinical trial evaluating mefloquine-IPTp versus sulfadoxine/pyrimethamine-IPTp were invited to participate and recto-vaginal swabs were collected at delivery for detection of GBS colonization. Prevalence of recto-vaginal GBS colonization was compared between IPTp regimens and risk factor and birth outcome analyses were computed.

Results: Among 549 participants, 106 were positive for GBS colonization at delivery (19%; 95% CI = 16%-23%). Prevalence of maternal GBS colonization showed no significant difference between the two IPTp regimens (mefloquine-IPTp: 67 of 366 women = 18%; 95% CI = 14%-22%; sulfadoxine/pyrimethamine-IPTp: 39 of 183 women = 21%; 95% CI = 15%-27%). Risk factor analysis for GBS colonization demonstrated a significant association with illiteracy (adjusted OR = 2.03; 95% CI = 1.25-3.30). GBS colonization had no impact on birth outcome, anaemia at delivery, gestational age and birth weight.

Conclusions: Sulfadoxine/pyrimethamine did not reduce colonization rates when used as the IPTp drug during pregnancy. Illiteracy was associated with GBS colonization.

Keywords: Streptococcus agalactiae; intermittent preventive treatment in pregnancy; maternal GBS colonization; sub-Saharan Africa.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / administration & dosage*
  • Antimalarials / administration & dosage*
  • Drug Combinations
  • Female
  • Gabon
  • Humans
  • Malaria / prevention & control
  • Mefloquine / administration & dosage*
  • Pregnancy
  • Pregnancy Complications, Infectious / prevention & control*
  • Pyrimethamine / administration & dosage*
  • Randomized Controlled Trials as Topic
  • Rectum / microbiology
  • Streptococcal Infections / microbiology
  • Streptococcal Infections / prevention & control*
  • Streptococcus agalactiae / isolation & purification*
  • Sulfadoxine / administration & dosage*
  • Vagina / microbiology
  • Young Adult


  • Anti-Bacterial Agents
  • Antimalarials
  • Drug Combinations
  • fanasil, pyrimethamine drug combination
  • Sulfadoxine
  • Mefloquine
  • Pyrimethamine