Community Pyrimethamine-Sulfadoxine Use and Prevalence of Resistant Plasmodium falciparum Genotypes in Mali: A Model for Deterring Resistance

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  • Molecular Biology of Plasmodia and Malaria Field Studies Unit, Center for Vaccine Development/Division of Geographic Medicine, Department of Medicine, University of Maryland School of Medicine, Malaria Genetics Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Epidemiology of Parasitic Diseases and Malaria Research and Training Center, National School of Medicine and Pharmacy, Baltimore, Maryland, Mali
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Pyrimethamine-sulfadoxine (PS, Fansidar™; Hoffman-LaRoche, Basel, Switzerland) is now the first-line antimalarial therapy in parts of Africa with high rates of chloroquine-resistant Plasmodium falciparum. With PS resistance increasing and no suitably inexpensive and effective third antimalarial drug available, strategies for delaying the spread of PS resistance in Africa are needed. Community PS usage was measured in two Malian villages, one rural and one periurban, and prevalence of pyrimethamine-resistant P. falciparum genotypes was determined at these sites and two urban sites. The prevalence of resistant genotypes was 22.6% (n = 84) in the periurban village where PS was available from multiple sources and large stocks of PS were observed, and 13.5% (n = 89) and 23.4% (n = 77) in a large town and a city, respectively, where PS is widely available. No pyrimethamine-resistant genotypes (n = 58) were detected in Kolle, a rural village with a community-supported dispensary and clinic where PS is used sparingly and no PS was available in pharmacies or markets. The high rates of pyrimethamine resistant genotypes concurrent with higher PS usage argue for a policy of judicious PS use in Mali and in similar settings. A possible model for slowing the spread of drug-resistant malaria is illustrated by the example of the Kolle clinic.