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We estimated the frequency of clinically diagnosed Stevens-Johnson syndrome and toxic epidermal necrolysis associated with sulfadoxine-pyrimethamine (SP) and trimethoprim-sulfamethoxazole (CTX) in Blantyre District, Malawi. Cases were detected by passive surveillance at 22 health centers from March 2001 through September 2002. Denominators were estimated from the Malawi national census for Blantyre District and the frequency of SP and CTX use reported in five household surveys. Crude rates of adverse reactions were estimated to be 1.2 per 100,000 exposures for SP and 1.5 per 100,000 exposures for CTX. Rates were higher in adults (1.7 cases per 100,000 SP exposures and 2.6 cases per 100,000 CTX exposures) and in persons positive for human immunodeficiency virus (4.9 cases per 100,000 SP exposures and 8.4 cases per 100,000 CTX exposures). Infrequent treatment doses with SP are associated with a low risk of an adverse cutaneous reaction, and SP can be recommended for treatment of malaria in areas where P. falciparum is susceptible.
Received August 18, 2005. Accepted for publication November 19, 2005.
Acknowledgments: We thank the Blantyre District Health Management Team for their support in designing and implementing the surveillance system. We also thank the laboratory staff at the Queen Elizabeth Central Hospital for conducting quality assurance for HIV testing.
Financial support: This project was supported by the United States Agency for International Development (USAID) under the Community Health Partnerships Project and the African Integrated Malaria Initiative in partnership with the Blantyre District Health Office and the Malawi Ministry of Health and Population, Lilongwe, Malawi.
Disclaimer: The opinions or assertions contained in this manuscript are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Public Health Service or Department of Health and Human Services. Use of trade names is for identification only and does not imply endorsement by U.S. Public Health Service or Department of Health and Human Services.
* Address correspondence to John E. Gimnig, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Chamblee, GA 30341. E-mail: hzg1{at}cdc.gov
Authors’ addresses: John E. Gimnig, John R. MacArthur, Robert D. Newman, and Richard W. Steketee, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Chamblee, GA 30341, E-mail: hzg1{at}cdc.gov. Maurice M’bang’ombe and Chris Mkandala, Blantyre District Health Office, Chipatala Avenue, Blantyre, Malawi. Michael H. Kramer, Institute for Hygiene and Public Health, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany. Nyson Chizani and Carl H. Campbell, Blantyre Integrated Malaria Initiative, Private Bag 240, Chipatala Avenue, Blantyre, Malawi. Robert S. Stern, Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215.
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