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Parasite clearance and protection from Plasmodium falciparum infection (PCPI): a two-arm, parallel, double-blinded, placebo-controlled, randomised trial of presumptive sulfadoxine-pyrimethamine versus artesunate monotherapy among asymptomatic children 3-5 years of age in Zambia.

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Related Experiment Video

Updated: May 7, 2026

Methods to Investigate the Regulatory Role of Small RNAs and Ribosomal Occupancy of Plasmodium falciparum
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Published on: December 4, 2015

Mapping 'partially resistant', 'fully resistant', and 'super resistant' malaria.

Inbarani Naidoo1, Cally Roper

  • 1Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK; Malaria Research Unit, Medical Research Council, PO Box 70380 Overport 4067, South Africa.

Trends in Parasitology
|September 14, 2013
PubMed
Summary

Sulfadoxine-pyrimethamine (SP) resistance threatens malaria prevention in Africa. Regional genetic differences in dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) mutations show varying resistance levels, impacting treatment efficacy.

Keywords:
drug resistanceintermittent preventive treatment (IPT)malariasulfadoxine–pyrimethamine (SP)super resistance

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Area of Science:

  • Malariology
  • Genetics
  • Public Health

Background:

  • Sulfadoxine-pyrimethamine (SP) is a key antimalarial drug used for intermittent preventive treatment (IPT) in Africa.
  • Growing resistance to SP poses a significant threat to its continued efficacy in malaria control programs.

Purpose of the Study:

  • To map recent surveys of dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) mutations.
  • To identify regional genetic differences in SP resistance across Africa.
  • To assess the impact of these mutations on SP efficacy.

Main Methods:

  • Analysis of recent survey data on dhfr and dhps mutations.
  • Genotyping of parasite populations to identify specific resistance-conferring mutations.
  • Correlation of mutation profiles with reported SP treatment failures.

Main Results:

  • Significant regional variations in SP resistance genotypes were observed.
  • West Africa shows a 'partially resistant' profile (dhfr N51I, N59R, S108N with dhps A437G).
  • East Africa exhibits a 'fully resistant' profile (dhfr N51I, N59R, S108N with dhps A437G+K540E).
  • Three East African foci display 'super resistance' with additional dhps 581G and/or dhfr 164L mutations.
  • SP-IPT failures reported in 'super resistant' areas.

Conclusions:

  • Regional genetic diversity in malaria parasite resistance genes (dhfr, dhps) significantly impacts SP efficacy.
  • The emergence of 'super resistant' strains necessitates a review of SP-IPT strategies in affected regions.
  • Understanding resistance patterns is crucial for maintaining effective malaria prevention and control.