Sulfadoxine-pyrimethamine toxicity among malaria patients in a developing tertiary institution: A 10 year assessment

Abstract

Background: Adverse effects such as Stevens Johnson syndrome and Toxic Epidermal Necrolysis following the use of sulfonamide containing antimalarials seems to be on the increase despite the adoption of the new policy for malaria treatment in Nigeria. Aim: To assess the pattern and prevalence of Stevens Johnson syndrome and Toxic Epidermal Necrolysis in the use of sulfadoxine-pyrimethamine as reported in the Accident and Emergency Centre of the University of Benin Teaching Hospital, Benin City, Nigeria between the year 2001 and 2010. Materials and Methods: Reported cases of Stevens Johnson syndrome and Toxic Epidermal Necrolysis were assessed retrospectively by using patient records. Results: Twenty-one patients reported with Stevens Johnson syndrome and Toxic Epidermal Necrolysis. The male to-female? of 2.8:1, 26 ± 1.6 years (mean ± standard deviation). Three of the victims had their drugs after obtaining standard prescription and 18 self-administered their drugs. Eighteen of them claimed to have been treating malaria while three had theirs for prophylaxis. The highest incidence was in the year 2008 and 2010. Sixteen (76.19 %) of the cases or patients procured their drugs from unregistered shops. Nine (42.58 %) cases or patients repeated their drugs during therapy when they felt that the dosage at initiation of therapy did not work for them. Two of the patients were known HIV/AIDS patients. Zinc-oxide powder was the most common topical drug applied during hospitalization. Severity was paramount in all at the time of report. Skin eruption was very common. Only two of them did not survive after management. Conclusions: The study showed that fatalities associated with the use of sulfadoxine-pyrimethamine were severe. Therefore, adequate measures are recommended through public enlightenment in ensuring adherence to regulatory policies.