Plasmodium falciparum cross-resistance between trimethoprim and pyrimethamine.
Trimethoprim-sulfamethoxazole has been recommended as part of the standard package of care for people with HIV and AIDS in Africa. A similar antifolate combination, sulfadoxine-pyrimethamine, is now the first-line antimalarial drug in several of the African countries with the highest rates of HIV infection. We present evidence of Plasmodium falciparum cross-resistance between trimethoprim and pyrimethamine at the molecular level. The impact of trimethoprim-sulfamethoxazole on the efficacy of sulfadoxine-pyrimethamine needs to be assessed urgently, and alternative antimalarial treatment should be considered for people on trimethoprim-sulfamethoxazole prophylaxis.
Iyer
J K
JK
Milhous
W K
WK
Cortese
J F
JF
Kublin
J G
JG
Plowe
C V
CV
D000349:Africa; D000483:Alleles; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D004351:Drug Resistance / Q000235:genetics; D005838:Genotype; D006801:Humans; D016778:Malaria, Falciparum / Q000517:prevention & control*; D010963:Plasmodium falciparum / Q000187:drug effects / Q000235:genetics*; D017354:Point Mutation; D011739:Pyrimethamine / Q000627:therapeutic use*; D013762:Tetrahydrofolate Dehydrogenase / Q000235:genetics*; D014295:Trimethoprim / Q000627:therapeutic use*
D000962:Antimalarials; D014295:Trimethoprim; D013762:Tetrahydrofolate Dehydrogenase; D011739:Pyrimethamine