Efficacy of sulfadoxine-pyrimethamine as first line treatment for malaria declining in Malawi

Question: After 10 years as the first-line antimalarial drug, has sulfadoxine-pyrimethamine retained efficacy in Malawi? Study design: Prospective cohort study. Main results: Outcomes measured at 14 days: over 5 years, adequate clinical response rates remained above 80% but parasitological responses significantly decreased (see Results table). Outcomes measured at 28 days: adequate clinical response rates decreased over 5 years (73% to 60%). Parasitological response rates also declined. Authors' conclusions: The rates of parasite clearance declined during the study, suggesting that other treatments should be investigated.