Sustained clinical efficacy of sulfadoxine-pyrimethamine for uncomplicated falciparum malaria in Malawi after 10 years as first line treatment: five year prospective study.
OBJECTIVE
To measure the efficacy of sulfadoxine-pyrimethamine treatment of falciparum malaria in Malawi from 1998 to 2002, after a change from chloroquine to sulfadoxine-pyrimethamine as first line treatment in that country in 1993.


METHODS
Prospective open label drug efficacy study.


METHODS
Health centre in large peri-urban township adjacent to Blantyre, Malawi.


METHODS
People presenting to a health centre with uncomplicated Plasmodium falciparum malaria.


METHODS
Therapeutic efficacy and parasitological resistance to standard sulfadoxine-pyrimethamine treatment at 14 days and 28 days of follow up.


RESULTS
Therapeutic efficacy remained stable, with adequate clinical response rates of 80% or higher throughout the five years of the study. Analysis of follow up to 28 days showed modest but significant trends towards diminishing clinical and parasitological efficacy over time within the study period.


CONCLUSIONS
Contrary to expectations, sulfadoxine-pyrimethamine has retained good efficacy after 10 years as the first line antimalarial drug in Malawi. African countries with very low chloroquine efficacy, high sulfadoxine-pyrimethamine efficacy, and no other immediately available alternatives may benefit from interim use of sulfadoxine-pyrimethamine while awaiting implementation of combination antimalarial treatments.
Plowe
Christopher V
CV
Malaria Section, Center for Vaccine Development, University of Maryland School of Medicine, 685 West Baltimore Street, HSF1-480, Baltimore, MD 21044, USA. cplowe@medicine.umaryland.edu
Kublin
James G
JG
Dzinjalamala
Fraction K
FK
Kamwendo
Deborah S
DS
Mukadam
Rabia A G
RA
Chimpeni
Phillips
P
Molyneux
Malcolm E
ME
Taylor
Terrie E
TE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004341:Drug Evaluation; D004351:Drug Resistance; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008295:Malawi; D008875:Middle Aged; D011446:Prospective Studies; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D016896:Treatment Outcome
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine