# Evidence on sulfadoxine-pyrimethamine resistance molecular markers from India: interpret with caution

## TL;DR

The paper warns that studies on sulfadoxine-pyrimethamine resistance in India may be misleading due to flawed methods and interpretations.

## Contribution

The paper highlights critical flaws in the analysis and interpretation of molecular resistance markers for sulfadoxine-pyrimethamine in India.

## Key findings

- Most studies on SP resistance markers in India have methodological flaws.
- Flawed interpretations can lead to incorrect policy decisions.
- Robust and standardized future studies are urgently needed.

## Abstract

Sulfadoxine-pyrimethamine (SP), as a partner to artesunate as ACT is the treatment of choice for uncomplicated P. falciparum infections in the majority of India and SP-resistance has a potential to lead to ACT failure. In the lack of robust surveillance of therapeutic efficacy of SP, validate molecular markers of SP-resistance offer a hint of failing SP. However, studies reporting these validated markers often suffer from certain pitfalls that warrant a careful interpretation.

Critical analyses of the results and their reported interpretations from a recent study and other studies conducted on the WHO-validated molecular markers of SP-resistance in India were analysed and the main problems with studying and reporting of these markers are presented here. It was noted that almost all studies analysed flawed either on the usage, estimation and/or interpretation of the standardized classification of the studies SP mutations. These flaws not only impart spatiotemporal incomparability of the published data but also have the potential of being misunderstood and wrongly translated.

Based on this universal problem in studying, reporting and interpreting the data from the studies on molecular markers of SP-resistance, it is stressed that the future studies should be conducted with utmost caution so that robust evidence may be generated and correctly translated to policy.