Is sulphadoxine-pyrimethamine (SP) still useful as the first-line antimalarial drug in Malawi or it must be quickly withdrawn from the antimalarial repertoire?

In recent years our efforts to control malaria successfully have been severely hampered by widespread and highlevel resistance to front-line antimalarial drugs. In 1993, Malawi had to replace chloroquine (CQ) with sulphadoxinepyrimethamine (SP) as the first-line antimalarial owing to unacceptably high rates of CQ failure. Thirteen years after this change in treatment policy, Malawi is faced with a scenario that calls for yet another switch to a different first-line antimalarial. In vivo SP resistance has already exceeded critical levels recommended by the World Health Organization for a treatment policy change. A decision to change has been made by the national Malaria Control Programme: delay in implementing this decision could have serious consequences for Malawi.