Sulfadoxine-pyrimethamine may still have a future despite reports of resistance

For many years the treatment of malaria in Africa has relied on chloroquine, sulfadoxine combined with pyrimethamine, and quinine, with the latter being used mainly to treat severe cases. Quinine remains efficacious, but chloroquine and sulfadoxine-pyrimethamine are failing, and this is leading to an increase in mortality from malaria especially in East Africa.1 2

Although resistance to chloroquine was first detected on the east coast of Africa in 1977, the drug has provided effective treatment for malaria for much of Africa for over 20 years.3 4 Unfortunately this is unlikely to be the case for sulfadoxine-pyrimethamine, the combination adopted by several African countries as the first line treatment for malaria when chloroquine has failed. Systematic surveillance for resistance to malaria drugs and the results of trials of new drugs or drug combinations that could be used to replace chloroquine or sulfadoxine-pyrimethamine are showing a worryingly high level of resistance to sulfadoxine-pyrimethamine across eastern and southern parts of Africa.5 6 Resistance to sulfadoxine-pyrimethamine is particularly severe in north east Tanzania, where clinical failure rates of up …