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. Design Prospective open label drug efficacy study. Setting Health...

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Bibliographic Details
Published in:BMJ 2004-03, Vol.328 (7439), p.545-548
Main Authors: Plowe, Christopher V, Kublin, James G, Dzinjalamala, Fraction K, Kamwendo, Deborah S, Chimpeni, Phillips, Molyneux, Malcolm E, Taylor, Terrie E
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Anemia
Anemia - etiology
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antimalarials
Antimalarials - therapeutic use
Antiparasitic agents
Biological and medical sciences
Child
Child, Preschool
Clinical outcomes
Drug Combinations
Drug dosages
Drug Evaluation
Drug Resistance
Drug therapy
Efficacy
Failure
Falciparum malaria
Folic acid antagonists
Follow-Up Studies
Human protozoal diseases
Humans
Infant
Infectious diseases
Malaria
Malaria, Falciparum - drug therapy
Malawi
Medical sciences
Medical treatment
Medical treatment failures
Middle Aged
Parasitemia
Parasites
Parasitic diseases
Parasitology
Pharmacology. Drug treatments
Plasmodium falciparum
Prospective Studies
Protozoal diseases
Pyrimethamine - therapeutic use
Pyrimethamine-sulphadoxine
Sulfadoxine - therapeutic use
Treatment
Treatment Outcome
Trends
Vomiting
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Summary: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. Design Prospective open label drug efficacy study. Setting Health centre in large peri-urban township adjacent to Blantyre, Malawi. Participants People presenting to a health centre with uncomplicated Plasmodium falciparum malaria. Main outcome measures 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. Conclusion 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.
ISSN:0959-8138
0959-8146
0959-535X
1468-5833
1756-1833
DOI:10.1136/bmj.37977.653750.EE