BMJ  2004;328:1259 (22 May), doi:10.1136/bmj.328.7450.1259

Letter

Sulfadoxine-pyrimethamine for uncomplicated falciparum malaria

Sulfadoxine-pyrimethamine is not working in Malawi

The first 150 words of the full text of this article appear below.

EDITOR—The paper by Plowe et al entitled "Sustained clinical efficacy of sulfadoxine-pyrimethamine for uncomplicated falciparum malaria" might be better titled "Sustained lack of efficacy of sulfadoxine-pyrimethamine...."¹ By the start of the study period five years ago, molecular genotyping showed that Plasmodium falciparum in Malawi had already acquired significant resistance to the combination.^{1 2} This explains the sustained lack of efficacy; 28 day cure rates in children with acute falciparum malaria remained steadily less than 40% over the five year study period. This is confirmed by the Malawi component of recent WHO-Special Programme for Research and Training in Tropical Diseases (TDR) multicentre trials; the 28 day cure rate with sulfadoxine-pyrimethamine in children with acute falciparum malaria was only 23%,³ and this for a major killing disease of childhood. A 77% failure rate is among the worst responses ever documented. Only 7% (5/71) of reported trials on sulfadoxine-pyrimethamine have had worse . . . [Full text of this article]

Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok 10400, Thailand nickw@tropmedres.ac

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Relevant Article

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, James G Kublin, Fraction K Dzinjalamala, Deborah S Kamwendo, Rabia A G Mukadam, Phillips Chimpeni, Malcolm E Molyneux, and Terrie E Taylor
BMJ 2004 328: 545. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Laufer, M. K., Djimde, A. A., Plowe, C. V. (2007). Monitoring and Deterring Drug-Resistant Malaria in the Era of Combination Therapy. Am J Trop Med Hyg 77: 160-169 [Abstract] [Full text]  

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