Mabuza, Aaron, Govere, John, la Grange, Kobus, Mngomezulu, Nicros, Allen, Elizabeth, Zitha, Alpheus, Mbokazi, Frans, Durrheim, David, and Barnes, Karen (2005) Therapeutic efficacy of sulfadoxine-pyrimethamine for Plasmodium falciparum malaria: a study 5 years after implementation of combination therapy in Mpumalanga, South Africa. South African Medical Journal, 95 (5). pp. 346-349.

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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. The study was conducted between January and June 2002.

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. 134 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.

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