Rapid Increase in the Prevalence of Sulfadoxine-Pyrimethamine Resistance among Plasmodium falciparum Isolated from Pregnant Women in Ghana

• Published in: The Journal of infectious diseases Vol. 198; no. 10; pp. 1545 - 1549
• Main Authors: Mockenhaupt, Frank P., Bedu-Addo, George, Eggelte, Teunis A., Hommerich, Lena, Holmberg, Ville, von Oertzen, Christa, Bienzle, Ulrich
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.11.2008; University of Chicago Press
• Subjects: Adolescent; Adult; Alleles; Anemia; Animals; Antimalarials - therapeutic use; Biological and medical sciences; Blood; Chemoprevention; DNA, Protozoan - genetics; Drug Combinations; Drug Resistance - genetics; Female; Fundamental and applied biological sciences. Psychology; Gender equality; Gene Frequency; Genetic mutation; Ghana - epidemiology; Humans; Infectious diseases; Life cycle. Host-agent relationship. Pathogenesis; Malaria; Malaria, Falciparum - drug therapy; Malaria, Falciparum - parasitology; Medical sciences; Microbiology; Middle Aged; Mutation - genetics; Parasites; Plasmodium falciparum; Plasmodium falciparum - genetics; Pregnancy; Pregnancy Complications, Parasitic - drug therapy; Pregnancy Complications, Parasitic - parasitology; Protozoa; Pyrimethamine - therapeutic use; Sulfadoxine - therapeutic use; Tetrahydrofolate Dehydrogenase - genetics; Women; Young Adult; Ghana; Africa; Human; Protozoa; Antimalarial; Apicomplexa; Prevalence; Microbiology; Pyrimethamine; Epidemiology; Infection; Resistance; Plasmodium falciparum; Sulfonamides; Parasiticide; Female; Antiinfectious; Sulfadoxine; Antibacterial agent
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/592455

Use of intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) during pregnancy (IPTp-SP) has become policy in much of sub-Saharan Africa but crucially depends on the efficacy of SP. We assessed the frequency of the dhfr triple mutation among Plasmodium falciparum isolates obtained from pregnant Ghanaian women in 1998, 2000, and 2006. The prevalence of the triple mutation, which confers resistance to SP, doubled from 36% to 73% during the study period (P < .001). In 2006, the prevalence was virtually identical among women of early gestation and delivering women with or without a history of IPTp-SP use, indicating that such treatment did not select for mutant parasites. Nevertheless, IPTp-SP may be outdated by drug resistance before it is fully implemented.