Volume 73, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


In Malawi, trimethoprim-sulfamethoxazole (TS) is the recommended first-line treatment for children with Integrated Management of Childhood Illness dual classifications of malaria and pneumonia, and sulfadoxine-pyrimethyamine (SP) plus five days of treatment with erythromycin (SP plus E) is the recommended second-line treatment. Using a 14-day, modified World Health Organization protocol, children with dual IMCI classifications of malaria and pneumonia with parasitemia were randomized to receive TS or SP plus E. Clinical and parasitologic responses and gametocytemia prevalence were obtained. A total of 87.2% of children receiving TS and 80.0% receiving SP plus E reached adequate clinical and parasitologic responses (ACPRs) ( = 0.19). Severely malnourished children were less likely to achieve ACPRs than those better nourished (relative risk = 3.34, = 0.03). Day 7 gametocyte prevalence was 55% and 64% among children receiving TS and SP plus E, respectively ( = 0.19). Thus, TS and SP plus E remain efficacious treatment of malaria in this setting. However, patient adherence and effectiveness of five days of treatment with TS is unknown.


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  1. Bloland PB, Redd S, Kazembe P, Tembenu R, Wirima J, Camp-bell C, 1991. Co-trimoxazole for childhood febrile illness in malaria-endemic regions. Lancet 337 : 518–520. [Google Scholar]
  2. Daramola OO, Alonso PL, Tjtwumasi P, McArdle TF, Greenwood BM, 1991. Sensitivity of Plasmodium falciparum in The Gambia to co-trimoxazole. Trans R Soc Trop Med Hyg 85 : 345–348. [Google Scholar]
  3. MacArthur J, Stennies G, Macheso A, Kolczak M, Green M, Ali D, Barat L, Kazembe P, Ruebush T, 2001. Efficacy of mefloquine and sulfadoxine-pyrimethamine for the treatment of uncomplicated Plasmodium falciparum infection in Machinga District, Malawi, 1998. Am J Trop Med Hyg 65 : 679–684. [Google Scholar]
  4. Jayasree I, Milhous W, Cortese J, Kublin J, Plowe C, 2001. Plasmodium falciparum cross-resistance between trimethoprim and pyrimethamine. Lancet 358 : 1066–1067. [Google Scholar]
  5. Feikin DR, Dowell SF, Nwanyanwu OC, Klubman K, Kazembe P, Barat L, Graf C, Bloland P, Ziba C, Heubner R, Schwartz B, 2000. Increased carriage of Trimethoprim.sulfamethoxazole-resitant Streptococcus pneumoniae in Malawian children after treatment for malaria with Sulfadoxine-pyrimethamine. J Infect Dis 81 : 1501–1505. [Google Scholar]
  6. Steketee RW, Wirima JJ, Slutsker WL, Khoromana CO, Breman JG, Heymann DL, 1996. Objectives and methodology in a study of malaria treatment and prevention in pregnancy in rural Malawi: the Mangochi Malaria Research Project. Am J Trop Med Hyg 55 : 8–16. [Google Scholar]
  7. WHO Division of Control of Tropical Diseases, 1996. Assessment of the Efficacy of Antimalarial Drugs for Uncomplicated falciparum Malaria in Areas with Intense Transmission. Geneva: World Health Organization. WHO/Mal/96.1077.
  8. WHO Division of Control of Tropical Diseases, 2003. Assessment and Monitoring of Antimalarial Drug Efficacy for the Treatment of Uncomplicated falciparum Malaria. Geneva: World Health Organization. WHO/HTM/RBM/2003.50
  9. Steadke SG, Kamya M, Dorsey G, Gasasira A, Ndeezi G, Charlebois E, Rosenthal P, 2001. Amodiaquine, sulfadoxine-pyrimethamine, and combination therapy for treatment of uncomplicated falciparum malaria in Kampala, Uganda: a randomized trial. Lancet 358 : 368–374. [Google Scholar]
  10. Kilian AH, Jelinek T, Prislin I, Kabagambe G, Byamukama W, Mpigika G, Korte R, von Sonnenburg F, 1998. Resistance in vivo of Plasmodium falciparum to co-trimoxazole in western Uganda. Trans R Soc Trop Med Hyg 92 : 197–200. [Google Scholar]
  11. Wolday D, Kibread T, Bukenya D, Hodes R, 1995. Sensitivity of Plasmodium falciparum in vivo to chloroquine and pyrimethamine-sulfadoxine in Rwandan patients in a refugee camp in Zaire. Trans R Soc Trop Med Hyg 89 : 654–656. [Google Scholar]
  12. von Seidlein L, Jawara M, Coleman R, Doherty T, Walraven G, Targett G, 2001. Parasitemia and gametocytaemia after treatment with chloroquine, pyrimethamine/sulfadoxine, and pyrimethamine/sulfadoxine combined with artesunate in young Gambians with uncomplicated malaria. Trop Med Int Health 6 : 92–98. [Google Scholar]
  13. Schellengberg D, Kahigwa E, Drakeley C, Malende A, Wigayi J, Msokame C, Aponte JJ, Tanner M, Mshinda H, Menendez C, Alonso PL, 2002. The safety and efficacy of sulfadoxine-pyrimethamine, amodiaquine, and their combination in the treatment of uncomplicated Plasmodium falciparum malaria. Am J Trop Med Hyg 67 : 17–23. [Google Scholar]
  14. Mendez F, Munoz A, Carrasquilla G, Jurado D, Arevalo-Herrera M, Cortese J, Plowe C, 2002. Determinants of treatment response to sulfadoxine-pyrimethamine and subsequent transmission potential in falciparum malaria. Am J Epidemiol 156 : 230–238. [Google Scholar]
  15. Robert V, Awono-Ambene HP, Le Hesran JY, Trape JF, 2000. Gametocytemia and infectivity to mosquitoes of patients with uncomplicated Plasmodium falciparum malaria attacks treated with chloroquine or sulfadoxine plus pyrimethamine. Am J Trop Med Hyg 62 : 210–216. [Google Scholar]
  16. Akim NI, Drakeley C, Kingo T, Simon B, Senkoro K, Sauerwein RW, 2000. Dynamics of P. falciparum gametocytemia in symptomatic patients in an area of intense perennial transmission in Tanzania. Am J Trop Med Hyg 63 : 199–203. [Google Scholar]
  17. Targett G, Drakeley C, Jawara M, von Seidlein L, Coleman R, Deen J, Pinder M, Doherty T, Southerland C, Walraven G, Milligan P, 2001. Artesunate reduces but does not prevent post treatment transmission of Plasmodium falciparum to Anopheles gambiae. J Infect Dis 183 : 1254–1259. [Google Scholar]
  18. Plowe C, Kublin J, Dzinjalamala F, Kamwendo D, Mukadam R, Chimpeni P, Molyneux M, Taylor T, 2004. Sustained clinical efficacy of sulfadoxine-pyrimethamine for uncomplicated falciparum malaria in Malawi after 10 years as first line treatment: five year prospective study. BMJ 328 : 762–767. [Google Scholar]
  19. Takechi M, Matsuo M, Ziba C, Macheso A, Butao D, Zungu IL, Chakanika I, Bustos MDG, 2001. Therapeutic efficacy of sulphadoxine/pyrimethamine and susceptibility in vivo of P. falciparum isolates to sulphadoxine-pyremethamnine and other antimalarial drugs in Malawian children. Trop Med Int Health 6 429–434. [Google Scholar]
  20. Nwanyanwu OC, Ziba C, Macheso A, Kazembe P, 2000. Efficacy of sulfadoxine-pyrimethamine for acute uncomplicated malaria due to P. falciparum in Malawian children under five years old. Trop Med Int Health 5 : 355–358. [Google Scholar]
  21. Verhoeff F, Brabin B, Masache P, Kachale B, Kazembe P, van der Kaay HG, 1997. Parasitological and haematological responses to treatment of Plasmodium falciparum malaria with sulphamethoxazole-pyrimethamine in southern Malawi. Ann Trop Med Parasitol 91 : 133–140. [Google Scholar]
  22. Nwanyanwu OC, Ziba A, Kazembe P, Chitsulo L, Wirima J, Kumwenda N, Redd S, 1996. Efficacy of sulphadoxine/pyrimethamine for Plasmodium falciparum malaria in Malawian children under five years of age. Trop Med Int Health 1 : 231–235. [Google Scholar]
  23. Bloland P, Lackritz E, Kazembe PN, Were JBO, Steketee R, Campbell CC, 1993. Beyond chloroquine: implications of drug resistance for evaluating malaria therapy efficacy and treatment policy in Africa. J Infect Dis 167 : 932–937. [Google Scholar]
  24. Heymann DL, Khoromana CO, Wirima JJ, Campbell CC, 1987. Comparative efficacy of alternative primary therapies for Plasmodium falciparum infections in Malawi. Trans R Soc Trop Med Hyg 81 : 722–724. [Google Scholar]

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  • Received : 10 Sep 2004
  • Accepted : 13 Apr 2005

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