Abstract
In their excellent review article, Sibley et al. [ 1. Sibley C.H. et al. Pyrimethamine–sulfadoxine resistance in Plasmodium falciparum: what next?. Trends Parasitol. 2001; 17: 582-588 Abstract Full Text Full Text PDF PubMed Scopus (301) Google Scholar ] remind us of the public health disaster facing sub-Saharan Africa if Plasmodium falciparum develops resistance to pyrimethamine–sulfadoxine as quickly as it did in Southeast Asia and South America because ‘no inexpensive alternative is currently available’. The authors also point out that continuous use of pyrimethamine–sulfadoxine will probably select highly resistant alleles of dhfr and dhps, resulting in falciparum infections becoming resistant even to chlorproguanil–dapsone – the main alternative antifolate combination being developed at present to replace pyrimethamine–sulfadoxine [ 1. Sibley C.H. et al. Pyrimethamine–sulfadoxine resistance in Plasmodium falciparum: what next?. Trends Parasitol. 2001; 17: 582-588 Abstract Full Text Full Text PDF PubMed Scopus (301) Google Scholar ]. This has already happened in Thailand [ 2. Wilairatana P. et al. Poor efficacy of antimalarial biguanide–dapsone combinations in the treatment of acute, uncomplicated, falciparum malaria. Ann. Trop. Med. Parasitol. 1997; 91: 125-132 Crossref PubMed Scopus (42) Google Scholar ].
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