Azithromycin for treating uncomplicated malaria

Azithromycin is not useful as monotherapy for uncomplicated malaria. In combinations with other antimalarials, it may need to be used at high doses, potentially affecting tolerability.

Anna M van Eijk*, Dianne J Terlouw

Liverpool School of Tropical Medicine, Child & Reproductive Health Group, Liverpool, UK

Azithromycin for treating uncomplicated malaria. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD006688.

To read the full review please follow this link: DOI: 10.1002/14651858.CD006688.pub2.

To help prevent the malaria parasite from developing resistance to antimalarial medicines, the WHO recommends the use of combination therapy, where malaria infections are treated with more than one drug simultaneously. As azithromycin is an antibiotic that also has an effect on the malaria parasite, we assessed its efficacy and tolerability as an antimalarial when used alone or as part of combination therapy with other antimalarials. Our review of studies conducted over the past 14 years suggests that azithromycin is a relatively weak antimalarial whose efficacy depends on the drug dose and the partner drug in the combination therapy. The data suggest that, among adults, the higher doses needed to achieve an acceptable level of treatment success with malaria may be less well tolerated. Unless the ongoing product and dose optimisation process results in a universally efficacious product or identifies a specific niche application that is complementary to the current scala of more efficacious antimalarial combinations, azithromycin's future as an antimalarial does not look promising.