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. 2004 Mar 6;328(7439):545.
doi: 10.1136/bmj.37977.653750.EE. Epub 2004 Feb 2.

Sustained clinical efficacy of sulfadoxine-pyrimethamine for uncomplicated falciparum malaria in Malawi after 10 years as first line treatment: five year prospective study

Christopher V Plowe  1 , James G Kublin, Fraction K Dzinjalamala, Deborah S Kamwendo, Rabia A G Mukadam, Phillips Chimpeni, Malcolm E Molyneux, Terrie E Taylor
Affiliations

Sustained clinical efficacy of sulfadoxine-pyrimethamine for uncomplicated falciparum malaria in Malawi after 10 years as first line treatment: five year prospective study

Christopher V Plowe et al. BMJ. .

Erratum in

  • BMJ. 2004 Mar 27;328(7442):762

Abstract

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.

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Figures

Figure 1
Figure 1
Sulfadoxine-pyrimethamine treatment outcomes, 1998-2002. Top left: therapeutic efficacy at 14 days; bottom left: therapeutic efficacy at 28 days; top right: parasitological resistance at 14 days; bottom right: parasitological resistance at 28 days. ACR=adequate clinical response; LTF=late treatment failure; ETF=early treatment failure; S=sensitive; RI-RIII=parasitological resistance at the RI-RIII levels
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Comment in

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