Cotrimoxazole prophylactic treatment prevents malaria in children in sub-Saharan Africa: systematic review and meta-analysis.

摘要: OBJECTIVES Cotrimoxazole prophylactic treatment (CPT) prevents opportunistic infections in HIV-infected or HIV-exposed children, but estimates of the effectiveness preventing malaria vary. We reviewed studies that examined effect CPT on incidence children sub-Saharan Africa. METHODS We searched PubMed and EMBASE for randomised controlled trials (RCTs) cohort mortality extracted data prevalence sulphadoxine-pyrimethamine resistance-conferring point mutations. Incidence rate ratios (IRR) from individual were combined using random effects meta-analysis; confounder-adjusted used studies. The importance resistance was meta-regression analyses. RESULTS Three RCTs four with 5039 (1692 HIV-exposed; 2800 HIV-uninfected; 1486 HIV-infected) included. Children less likely to develop clinical episodes than those without prophylaxis (combined IRR 0.37, 95% confidence interval: 0.21-0.66), there substantial between-study heterogeneity (I-squared = 94%, P < 0.001). protective efficacy highest an RCT Mali, where antifolate resistant plasmodia low. In analyses, some evidence declined increasing levels resistance. Mortality reduced Zambia, not a study Cote d'Ivoire. CONCLUSIONS Cotrimoxazole reduces Africa, designs, settings results heterogeneous. appears be beneficial as well HIV-uninfected children.