Malaria drug caught up in side effect scare

Tanzania's new first line drug for treating malaria, Sulphadoxine Pyrimethamine (SP), has been embroiled in a high profile media scare over its potential side effects.

Various newspapers have been publishing photos of patients, apparently suffering from skin reactions that they have developed after taking SP. Experts, however, have warned that these might be a few exaggerated incidents that have been blown out of proportion.

"I have been following these things in the press but there is nothing scientific," said Zul Prenji, Professor of Parasitic Infections at the Muhumbili Hospital in Dar es Salaam. "There is a lack of evidence and it is very likely that these are a small number of cases that have been over publicised in the media."

SP was adopted by the Tanzanian government as the frontline malaria drug in August last year after studies revealed that levels of parasitic resistance to the traditional drug, chloroquine, had exceeded 75 percent in some areas of the country.

From the outset, the potential side effects, a skin reaction known as Stephenson Johnson Syndrome, have been acknowledged, but considered to be minimal given the effectiveness of the drug.

"The data available on potential SP side effects relates to use as a weekly prophylaxis and estimates one case per 5,000-8,000. Post-market surveillance carried out by the manufacturers couldn't find any cases of side effects amongst those that took the recommended dosage for treatment," Alastair Unwin, Technical Advisor for the National Malaria Control Programme, told IRIN on Wednesday.

"So we know there is a risk, but we also know that we are dealing with a potentially fatal infection that, if untreated in children, carries a case fatality rate of anything up to 10 percent," he added.

Unwin explained that, as SP is a cheap drug "and the chances of making a lot of profit on its use and distribution are small", there are those who are prepared to undermine the government's new drug policy and are trying to get SP withdrawn from the market.

"There have been calls for people to go back to use chloroquine which doesn't work and which the government has removed from widespread availability. Then we would be left with a situation where we have many cases of a potentially fatal disease for which there is no drug available," he said.

Professor Prenji agreed that there might be those with vested interests in SP failing, but he added that another factor could be that patients prefer treatment by chloroquine as it eases the symptoms of malaria much faster than SP.

However, given the levels of concern, the consensus is that more research on the issue is necessary. "It is a very explosive situation and I feel there is a need for more research. Let's get some more evidence, then, if what is coming out is true, we can address it," said Professor Prenji.

Meanwhile, according to Dr Ali Mzige, Director of Preventative Sciences in the Ministry of Health, the government intends to tackle press reporting of the issue.

"Those people that are shouting are doing so without scientific proof," he told IRIN. "The people that are writing about this think it is sensational news, but in actual fact, you need to bring in scientific fact. We'll be inviting editors of the newspaper to a meeting on the issue because it is a question of reporting the correct thing."