Efficacy of sulfadoxine-pyrimethamine in the treatment of uncomplicated Plasmodium falciparum malaria in East Timor.
The efficacy of sulfadoxine-pyrimethamine (SP) in East Timor is unknown. We treated 38 individuals with uncomplicated Plasmodium falciparum malaria with SP and monitored the outcome for 28 days. Recrudescent parasitemia, confirmed by genotyping, were detected in three individuals resulting in a late treatment failure rate of 7.9% (95% confidence interval = 1.7-21.4%). The results suggest that SP is still efficacious in treating uncomplicated P. falciparum malaria in East Timor. However, the useful life of SP in East Timor may be limited because 80% of the parasites in our samples were found to already carry double mutations in P. falciparum dihydrofolate reductase (S108N/C59R). The data from this study also highlights that the presence of gametocytes may significantly influence the estimate of SP efficacy determined by genotyping.
Burns
Matthew
M
Medical Emergency Relief International, London, United Kingdom. mburns@jhsph.edu
Baker
Joanne
J
Auliff
Alyson M
AM
Gatton
Michelle L
ML
Edstein
Michael D
MD
Cheng
Qin
Q
D000293:Adolescent; D000328:Adult; D000368:Aged; D000483:Alleles; D000818:Animals; D000953:Antigens, Protozoan / Q000235:genetics; D000962:Antimalarials / Q000097:blood / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000737:chemistry / Q000235:genetics; D004094:Dihydropteroate Synthase / Q000235:genetics; D004338:Drug Combinations; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D020066:Merozoite Surface Protein 1 / Q000235:genetics; D008875:Middle Aged; D009154:Mutation; D010963:Plasmodium falciparum / Q000201:enzymology / Q000235:genetics / Q000254:growth & development*; D016133:Polymerase Chain Reaction; D015800:Protozoan Proteins / Q000235:genetics; D011739:Pyrimethamine / Q000097:blood / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000097:blood / Q000627:therapeutic use*; D013762:Tetrahydrofolate Dehydrogenase / Q000235:genetics; D049648:Timor-Leste; D016896:Treatment Outcome
D000953:Antigens, Protozoan; D000962:Antimalarials; D016054:DNA, Protozoan; D004338:Drug Combinations; D020066:Merozoite Surface Protein 1; D015800:Protozoan Proteins; C065974:merozoite surface protein 2, Plasmodium; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D013762:Tetrahydrofolate Dehydrogenase; D004094:Dihydropteroate Synthase; D011739:Pyrimethamine