Adverse skin reactions to sulfadoxine-pyrimethamine in western Kenya: implications for malaria treatment strategies

Abstract

With the increasing problem of chloroquine-resistant falciparum malaria in Kenya, treatment with alternative drugs such as sulfadoxine-pyrimethamine is becoming common. One of the side-effects associated with the use oftbis drug is adverse skin reactions. Hospital-based retrospective and prospective studies of adverse skin reactions to sulfadoxine-pyrimetharnine were undertaken in a holoendemic malaria area of western Kenya in order to understand the implications of treatment policies. In a retrospective study of 35,950 medical records for all conditions recorded between 1994-1995 in Kisumu District Hospital, only a small proportion (9.0%) were patients diagnosed with skin events. No cases of drug-induced skin reactions were diagnosed during this time period. In a retrospective study of 1,557 documented skin events from 1994-1995 in the outpatient skin clinic in New Nyanza Provincial General Hospital, druginduced reactions constituted only 1% (16 cases). From a 12-month prospective study, a total of 33 patients were enrolled into the study Ten of the 33 patients had sulfadoxine-pyrimethamine minor skin reactions. There were no fatalities associated with sulfadoxine-pyrimethamine. Since the skin reactions are minor and not a major public problem, it is recommended that sulfadoxinepyrimethamine may be used for the treatment ofchloroquine-resistantfalcipanml malaria.