BMJ  2004;328:1259-1260 (22 May), doi:10.1136/bmj.328.7450.1259-a

Letter

Sulfadoxine-pyrimethamine for uncomplicated falciparum malaria

Treatment failure and resistance in Malawi remain subject for debate

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

EDITOR—The methods applied to enhance the interpretation of the data by Plowe et al deserve comment.¹

The World Health Organization has developed several standardised protocols to assess the efficacy of antimalarial drugs, which are intended to determine treatment failures and not resistance patterns of the parasite. Recently, WHO published a revised protocol, giving clear indications of outcome classifications and the target groups (children under 5 years in intense transmission areas) to be monitored.² The new classification is appropriate for patients with symptoms and includes not only clinical but also parasitological criteria. It becomes redundant now to report the response based on the 1973 classification. Moreover, examination of WHO's database on antimalarial drug efficacy has shown that early treatment failure corresponds closely to parasitological resistance grade RIII + RII, contradicting the authors' claim that early treatment failure is systematically overestimating the true early failure rate.

A technical meeting convened . . . [Full text of this article]

Roll Back Malaria Department, World Health Organization, 1211 Geneva 27, Switzerland ringwaldp@who.int

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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
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