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The efficacy of sulfadoxine-pyrimethamine (SP) in East Timor is unknown. We treated 38 individuals with uncomplicated Plasmodium falciparum malaria with SP and monitored the outcome for 28 days. Recrudescent parasitemia, confirmed by genotyping, were detected in three individuals resulting in a late treatment failure rate of 7.9% (95% confidence interval = 1.7–21.4%). The results suggest that SP is still efficacious in treating uncomplicated P. falciparum malaria in East Timor. However, the useful life of SP in East Timor may be limited because 80% of the parasites in our samples were found to already carry double mutations in P. falciparum dihydrofolate reductase (S108N/C59R). The data from this study also highlights that the presence of gametocytes may significantly influence the estimate of SP efficacy determined by genotyping.
Received January 9, 2005. Accepted for publication November 6, 2005.
Acknowledgments: We are grateful to the staff members of the Los Palos Hospital for allowing us to use their facilities for the duration of the study, and especially Dr. Raumoldo Bosco, Eva dos Santos, Americo Fernandes, Edmundo Viera, Joãzinho da Cruz and, Julio dos Santos for their participation in the study. We also thank Kerryn Rowcliffe for performing the drug analysis. Finally, we thank Dr. Pascal Ringwald (World Health Organization) and Dr. Nadine Ezard (United Nations High Commissioner for Refugees) for their comments and manuscript alterations.
Financial support: This study was supported by the European Community Humanitarian Organization.
Disclaimer: The opinions expressed herein are those of the authors and do not necessarily reflect those of the Australian Defence Force, Defence Health Service, or any extant policy of Department of Defence, Australia.
* Address correspondence to Qin Cheng, Department of Drug Resistance and Diagnostics, Australian Army Malaria Institute, Gallipoli Barracks, Enoggera, Queensland 4051, Australia. E-mail: qin.cheng{at}defence.gov.au
Authors’ addresses: Matthew Burns, Centre for International Emergency, Disaster and Refugee Studies, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205. E-mails: simulium98{at}yahoo.com and mburns{at}jhsph.edu. Joanne Baker, Alyson M. Auliff, Michael D. Edstein, and Qin Cheng, Australian Army Malaria Institute, Weary Dunlop Drive, Gallipoli Barracks, Enoggera, Brisbane, Queensland 4051, Australia, Telephone: 61-7-3332-4801, Fax: 61-7-3332-4800, E-mails: Joanne.baker1{at}defence.gov.au, alyson.auliff{at}defence.gov.au, mike.edstein{at}defence.gov.au, and qin.cheng{at}defence.gov.au. Michelle L. Gatton, Malaria Drug Resistance and Chemotherapy, Division of Infectious Diseases and Immunology, Queensland Institute of Medical Research; Australian Centre for International and Tropical Health and Nutrition, University of Queensland, Post Office Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia, Telephone: 61-7-3362-0416, Fax: 61-7-3362-0104, E-mail: michelle.gatton{at}qimr.edu.au.
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