Single-Dose Sulfadoxine-Pyrimethamine in Intermittent Preventive Treatment of Malaria

Extract

To the Editor —Sulfadoxine-pyrimethamine (S-P), a safe and inexpensive drug, is widely used for intermittent preventive treatment (IPT) of malaria during pregnancy (IPTp) in Africa and is the prime candidate for use for IPT in infants (IPTi) (http://www.ipti-malaria.org). Marks et al. report that a single treatment dose of S-P can cause parasitological rebound and selection of drug-resistant parasites for a short period after drug clearance [1]. This conclusion has potentially serious implications for the IPT approach to reducing the burden of malaria during pregnancy and in children

We are concerned about the study methods and presentation of results by Marks et al.

The results of this study are far from clear. It is not surprising that subjects in the S-P arm had more episodes of infection and S-P resistance, because they were observed longer. The incidence of any malaria infection over the whole study period was similar in the S-P and placebo arms (2.86 vs. 2.67 episodes/year ). This may suggest rebound, since one would expect some prophylactic effect in the S-P arm that is not borne out in the overall incidence rates