Continued efficacy of sulfadoxine-pyrimethamine as second line treatment for malaria in children in Guinea-Bissau.
BACKGROUND
Sulfadoxine-pyrimethamine (S/P) is widely used for treatment of failures following the first line treatment for malaria in Africa. In Guinea-Bissau, it has been recommended as second line therapy by the National Malaria Programme since 1996. In order to monitor any change of the in vivo sensitivity, the efficacy of S/P was studied immediately before the introduction of the drug and 6-9 years later.


METHODS
Children participating in clinical in vivo studies were given S/P if having late clinical treatment failure following the treatment with quinine, chloroquine, or amodiaquine. Parasitological and clinical failures were evaluated during a 35-day follow-up. During the first study period whole blood sulfadoxine concentrations were measured on day 7.


RESULTS
Altogether, 56 children failed the initial treatment and were included in 1995/1996 as well as 55 children in 2002/2004. The PCR-uncorrected adequate clinical and parasitological response rates on day 28 were 94% and 91%, and on day 35 they were 89% and 91%, respectively, in the two periods. No difference between median blood drug concentration in children with and without treatment failure was observed.


CONCLUSIONS
The efficacy of S/P as second line treatment for uncomplicated malaria has remained unchanged in spite of a relatively high level of genetic markers associated with Plasmodium falciparum resistance to S/P previously found in the area.
Kofoed
Poul-Erik
PE
Projecto de Saúde de Bandim, Guinea-Bissau. POERKO@FKS.VejleAmt.dk
Rodrigues
Amabelia
A
Aaby
Peter
P
Rombo
Lars
L
D000293:Adolescent; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D005260:Female; D006169:Guinea-Bissau; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D018512:Parasitemia; D010963:Plasmodium falciparum; D011739:Pyrimethamine / Q000008:administration & dosage*; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000493:pharmacokinetics; D013607:Tablets / Q000008:administration & dosage; D017211:Treatment Failure; D014505:Urban Population
D000962:Antimalarials; D004338:Drug Combinations; D013607:Tablets; D013413:Sulfadoxine; D011739:Pyrimethamine