Due to the spread of chloroquine resistant strains of P.falciparum many African countries have adopted sulfadoxine-pyrimethamine (SP) as the second-line anti-malarial drug or even as the first-line treatment. We evaluated its usefulness in Guinea-Bissau.
Methods: Children who had been treated with quinine or chloroquine at the Bandim Health Centre were re-treated with SP (Fansidar) if having recurrent P.falciparum malaria. At day 7 a capillary blood sample was analysed for sulfadoxine whole blood concentration. At the weekly visits until day 35 the condition of the of children with persistent or recurring symptoms and parasitaemia after initial treatment with chloroquine. However, the use of SP should be restricted in order to minimise child was evaluated and a malaria film analysed.
Results: 56 children with a mean age of 5.1 years were included. The cumulative percentages of children with recurrent parasitaemia were: day 7: 0%(0/56), day 14: 0%(0/55), day 21: 4%(2/54), day 28: 6%(3/53), day 35: 12%(6/52). No adverse effects of the treatment were observed. For children with reappearing parasites the median sulfadoxine whole blood concentration on day 7 was 107 micromol/litre, and in children without reappearing parasites 96 micromol/litre (p=0.98).
Discussion: No difference was found between the concentrations of sulfadoxine on day 7 in children with and without recrudescence, indicating that differences in drug concentrations were not the reason for treatment failure. In spite of the increasing resistance to chloroquine in Guinea-Bissau this drug is still partly effective and should continue as first line therapy. As SP has been shown to be an effective alternative, all health facilities in Guinea-Bissau should have this second-line drug available for treatment the spread of resistance.