Therapeutic efficacy of sulfadoxine-pyrimethamine for Plasmodium falciparum malaria.

Abstract

OBJECTIVES:

To assess the therapeutic efficacy of sulfadoxinepyrimethamine (SP) after 5 years of use as first-line treatment of uncomplicated Plasmodium falciparum malaria, and thus guide the selection of artemisinin-based combination therapy in Mpumalanga, South Africa.

DESIGN:

An open-label, in vivo therapeutic efficacy study of patients with uncomplicated P. falciparum malaria treated with a single oral dose of SP, with response to treatment monitored clinically and parasitologically on days 1, 2, 3, 7, 14, 21, 28 and 42.

SETTING:

Mangweni and Naas public health care clinics, Tonga district in rural Mpumalanga. SUBJECTS, OUTCOME MEASURES AND RESULTS: Of 152 patients recruited sequentially, 149 (98%) were successfully followed up for 42 days. One hundred and thirty-four patients (90%) demonstrated adequate clinical and parasitological response. Of the 15 patients (10%) who failed treatment, 2 (1.3%) had an early treatment failure, and polymerase chain reaction confirmed recrudescent infection in all 13 patients (8.7%) who had late parasitological (N = 11) or clinical (N = 2) failure. Gametocyte carriage was prevalent following SP treatment (84/152) and this has increased significantly since implementation in 1998 (relative risk 2.77 (confidence interval 1.65 - 4.66); p = 0.00004).

CONCLUSION:

Asexual P. falciparum parasites in Mpumalanga remain sensitive to SP, with no significant difference between the baseline cure rate (94.5%) at introduction in 1998, and the present 90% cure rate (p = 0.14). However, since gametocyte carriage has increased significantly we recommend that SP be combined with artesunate in Mpumalanga to reduce gametocyte carriage and thus decrease malaria transmission and potentially delay antimalarial resistance.

• Authors: A Mabuza, J Govere, K La Grange, N Mngomezulu, E Allen, A Zitha, F Mbokazi, D Durrheim, K Barnes
• Journal: South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (S Afr Med J) Vol. 95 Issue 5 Pg. 346-9 (May 2005) ISSN: 0256-9574 [Print] South Africa
• PMID: 15931450 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Drug Combinations
• fanasil, pyrimethamine drug combination
• Sulfadoxine
• Pyrimethamine

Topics

• Adolescent
• Adult
• Animals
• Antimalarials (therapeutic use)
• Child
• Drug Combinations
• Female
• Humans
• Malaria, Falciparum (drug therapy, epidemiology)
• Male
• Plasmodium falciparum (drug effects)
• Prevalence
• Pyrimethamine (therapeutic use)
• South Africa (epidemiology)
• Sulfadoxine (therapeutic use)
• Treatment Outcome