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Resistance to the antifolate sulfadoxine-pyrimethamine (SP), the current mass-treatment antimalarial drug, is associated with selection of point mutations in dihydrofolate reductase and dihydropteroate synthase. Among these mutations, the leucine 164 dihydrofolate reductase mutation (Leu-164) is associated with higher levels of SP resistance; this mutation is also associated with a decrease in the efficacy of chlorproguanil/dapsone, a newly developed antifolate antimalarial drug. Leu-164 has been detected in Southeast Asia and South America, regions where SP is no longer effective. Surprisingly, this mutation has not yet been detected in Africa, using the standard protocol based on PCR-RFLP, despite high SP resistance. In this paper, we discuss briefly the reasons why Leu-164 has not yet been selected in Africa and we propose a means that may slow down the selection of this mutation.

Original publication

DOI

10.1016/j.trstmh.2004.07.002

Type

Journal article

Journal

Trans R Soc Trop Med Hyg

Publication Date

05/2005

Volume

99

Pages

341 - 346

Keywords

Africa, Animals, Antimalarials, Drug Combinations, Drug Resistance, Humans, Malaria, Falciparum, Plasmodium falciparum, Point Mutation, Pyrimethamine, Sulfadoxine, Tetrahydrofolate Dehydrogenase