Current Trends Adverse Reactions to Fansidar and Updated
Recommendations for Its Use in the Prevention of Malaria
Since pyrimethamine-sulfadoxine (Fansidar) became available in
United States in 1982, it has been an integral part of the malaria
prophylaxis regimen that CDC recommends for travelers at risk of
exposure to chloroquine-resistant Plasmodium falciparum (CRPF). As
the areas of the world with transmission of CRPF have expanded, the
number of U.S. travelers using Fansidar has increased. Fansidar is
usually well tolerated; however, as with other sulfonamides, severe
adverse reactions associated with its use have been reported (1-5).
During the past 3 months, additional cases to those reported in the
literature of severe cutaneous reactions (erythema multiforme,
Stevens-Johnson syndrome, and toxic epidermal necrolysis)
with the use of Fansidar over the past 2 years have been reported
CDC. These 10 cases (four fatal) that have occurred among U.S.
travelers are currently being investigated by CDC in coordination
the U.S. Food and Drug Administration and the drug manufacturer.
addition, there is a collaborative effort under way to assess the
risks associated with the use of this drug for malaria prophylaxis.
Until the risk of adverse reactions to Fansidar is more
defined, CDC recommends the following:
Chloroquine remains the primary drug of choice for
to all malarious areas (6).
When considering the use of Fansidar for chemoprophylaxis
CRPF, physicians should carefully question travelers regarding
previous history of sulfonamide intolerance. Fansidar should
be prescribed if there is any history of previous untoward
reaction to sulfonamides.
Travelers to CRPF regions in Asia or South America should
take Fansidar in addition to chloroquine only if they stay
overnight in rural areas. Travelers visiting urban areas of
and South America are at low risk of acquiring malaria, as are
travelers to rural areas during daytime hours, because
mosquitoes bite during the evening and nighttime hours.
Travelers to areas of east and central Africa where
transmission of CRPF has been documented should continue to use
the combination of chloroquine and Fansidar. The risk of
acquiring CRPF in these areas is substantial because of the
intense transmission of malaria, especially in those rural
usually frequented by tourists.
Travelers should be advised to discontinue Fansidar use
immediately in the event of a possible ill effect, especially
any mucocutaneous signs or symptoms develop, such as pruritus,
erythema, rash, orogenital lesions, or pharyngitis.
Travelers should be informed that, regardless of the
prophylactic regimen employed, it is still possible to contract
malaria. Medical attention should be sought promptly in the
of a febrile illness, and the physician should be advised of
recent travel history and possibility of exposure to malaria.
The above recommendations differ from earlier statements and
should be applied as the most current information available (6-8).
CDC will update these interim malaria chemoprophylaxis
in the near future. Additional cases of adverse reactions to
should be reported to the Malaria Branch, Division of Parasitic
Diseases, Center for Infectious Diseases, CDC, telephone (404)
Reported by Malaria Br, Div of Parasitic Diseases, Center for
Infectious Diseases, Div of Quarantine, Center for Prevention Svcs,
Olsen VV, Loft S, Christensen K. Serious reactions during
prophylaxis with pyrimethamine-sulfadoxine (Letter). Lancet
Whitfield D. Presumptive fatality due to
pyrimethamine-sulfadoxine (Letter). Lancet 1982;II:1272.
Hornstein OP, Ruprecht KW. Fansidar-induced Stevens-Johnson
syndrome (Letter). N Engl J Med 1982;307:1529-30.
Ligthelm RJ, van Zwienen J, Stuiver PC, Djajadiningrat AP.
Syndroom van Stevens-Johnson en granulopenie tijdens het
van sulfadoxine-pyrimethamine (Fansidar). Ned Tijdschr Geneesk
Setia U. Fansidar-induced Stevens-Johnson syndrome and malaria
prophylaxis (Letter). Pediatr Infect Dis 1983;2:173-4.
CDC. Prevention of malaria in travelers 1982. MMWR
CDC. Imported malaria among travelers--United States. MMWR
CDC. Health information for international travel 1984.
Georgia: Centers for Disease Control, 1984; HHS publication
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