COMMUNITY PYRIMETHAMINE-SULFADOXINE USE AND PREVALENCE OF RESISTANT PLASMODIUM-FALCIPARUM GENOTYPES IN MALI - A MODEL FOR DETERRING RESISTANCE

Pyrimethamine-sulfadoxine (PS, Fansidar(TM); Hoffman-LaRoche, Basel, S witzerland) is now the first-line antimalarial therapy in parts of Afr ica with high rates of chloroquine-resistant Plasmodium falciparum. Wi th PS resistance increasing and no suitably inexpensive and effective third antimalarial drug available, strategies for delaying the spread of PS resistance in Africa are needed. Community PS usage was measured in two Malian villages, one rural and one periurban, and prevalence o f pyrimethamine-resistant P. falciparum genotypes was determined at th ese sites and two urban sites. The prevalence of resistant genotypes w as 22.6% (n = 84) in the periurban village where PS was available from multiple sources and large stocks of PS were observed, and 13.5% (n = 89) and 23.4% (n = 77) in a large town and a city, respectively, wher e PS is widely available. No pyrimethamine-resistant genotypes (n = 58 ) were detected in Kolle, a rural village with a community-supported d ispensary and clinic where PS is used sparingly and no PS was availabl e in pharmacies or markets. The high rates of pyrimethamine resistant genotypes concurrent with higher PS usage argue for a policy of judici ous PS use in Mall and in similar settings. A possible model for slowi ng the spread of drug-resistant malaria is illustrated by the example of the Kolle clinic.