Severe cutaneous reactions to sulfadoxine-pyrimethamine and trimethoprim-sulfamethoxazole in Blantyre District, Malawi

Am J Trop Med Hyg. 2006 May;74(5):738-43.

Abstract

We estimated the frequency of clinically diagnosed Stevens-Johnson syndrome and toxic epidermal necrolysis associated with sulfadoxine-pyrimethamine (SP) and trimethoprim-sulfamethoxazole (CTX) in Blantyre District, Malawi. Cases were detected by passive surveillance at 22 health centers from March 2001 through September 2002. Denominators were estimated from the Malawi national census for Blantyre District and the frequency of SP and CTX use reported in five household surveys. Crude rates of adverse reactions were estimated to be 1.2 per 100,000 exposures for SP and 1.5 per 100,000 exposures for CTX. Rates were higher in adults (1.7 cases per 100,000 SP exposures and 2.6 cases per 100,000 CTX exposures) and in persons positive for human immunodeficiency virus (4.9 cases per 100,000 SP exposures and 8.4 cases per 100,000 CTX exposures). Infrequent treatment doses with SP are associated with a low risk of an adverse cutaneous reaction, and SP can be recommended for treatment of malaria in areas where P. falciparum is susceptible.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Adverse Drug Reaction Reporting Systems
  • Aged
  • Antimalarials / adverse effects*
  • Child
  • Child, Preschool
  • Drug Combinations
  • Drug Eruptions / epidemiology*
  • Drug Eruptions / etiology
  • Drug Eruptions / pathology
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Malaria / blood
  • Malaria / drug therapy*
  • Malaria / epidemiology
  • Malaria / etiology
  • Malawi / epidemiology
  • Male
  • Middle Aged
  • Pregnancy
  • Pregnancy Complications, Parasitic / blood
  • Pregnancy Complications, Parasitic / drug therapy
  • Pregnancy Complications, Parasitic / epidemiology
  • Pregnancy Complications, Parasitic / etiology
  • Pyrimethamine / adverse effects*
  • Severity of Illness Index
  • Sulfadoxine / adverse effects*
  • Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects*

Substances

  • Antimalarials
  • Drug Combinations
  • fanasil, pyrimethamine drug combination
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Sulfadoxine
  • Pyrimethamine