Audit of failure rate of sulfadoxine/pyrimetham combined with chloroquine to treat falciparum malaria at single fourteen-day follow-up

Objective: To assess the failure rate of the present first line treatment regime for uncomplicated falciparum malaria of sulfadoxine/pyrimethamine combined with chloroquine.Design: A before-after study.Setting: Ndumo Clinic, Ingwavuma District, South Africa, October 2000 Study Group. 55 patients presenting to Ndumo clinic with uncomplicated malaria and malaria trophozoites visible on thin film.Main outcome measures: Trophozoite count on thick film at day 14.Results: 15 out of 37 patients who returned for follow-up still had trophozoites on thick film. Symptoms of most patients at day 0 and day l4 were mild, parasite counts before and after treatment were low, and trophozoites were atypical.Conclusions: There appears to be an unacceptably high day 14 failure rate with the combination of sulfadoxine/pyrimethamine and chloroguine.The mildness of symptoms, low parasite counts and atypical trophozoites suggest immunity to falciparum malaria amongst the local population. With few antimalarials to chose from, the difficult question as to future treatment of uncomplicated malaria arises.