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Diagnosis and Treatment |

Use of Pyrimethamine-Sulfadoxine (Fansidar) in Prophylaxis Against Chloroquine-Resistant Plasmodium falciparum and Pneumocystis carinii

RICHARD D. PEARSON, MD.; and ERIK L. HEWLETT, M.D.
[+] Article and Author Information

Grant support: In part by a grant from the Rockefeller Foundation.

▸Requests for reprints should be addressed to Richard D. Pearson, M.D.; Department of Medicine, Box 485, University of Virginia School of Medicine; Charlottesville, VA 22908.


Charlottesville, Virginia


©1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;106(5):714-718. doi:10.7326/0003-4819-106-5-714
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The widespread emergence of chloroquine-resistant Plasmodium falciparum led to the formulation of an effective, fixed combination of two antimalarial agents, pyrimethamine and the long-acting sulfonamide sulfadoxine, for prophylaxis and treatment. These drugs act at sequential steps to inhibit the formation of tetrahydrofolate in the parasite. Recently, their use for malaria prophylaxis has been associated with severe, at times fatal, cutaneous reactions including erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. These reactions have necessitated a major reassessment of the indications for pyrimethamine-sulfadoxine use and increased the search for pharmacologic, immunologic and behavioral approaches to the prophylaxis and treatment of infection with P. falciparum. Pyrimethamine-sulfadoxine may be effective in preventing recurrent pneumonia caused by Pneumocystis carinii in patients with the acquired immunodeficiency syndrome, but life-threatening cutaneous reactions have also been reported in this setting.

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