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Background  Sympatric existence of  Plasmodium falciparum  and  Plasmodium vivax , and the practice of malaria treatment without microscopic confirmation suggest that the accidental treatment of vivax malaria with sulfadoxine–pyrimethamine (SP) is common.    Methods  In this study, the frequency distribution of alleles associated with SP resistance were analysed among the  P. vivax  infections from malariometric surveys and its association with SP treatment failure in clinical studies in Indonesia. The  dhfr  and  dhps  alleles were detected using PCR–RFLP method.    Results  Analysis of 159  P. vivax  isolates from malariometric surveys and 69 samples from in vivo SP efficacy study revealed various the existence of various alleles of the  pvdhfr  and  pfdhps  genes including 57L/I, 58R, 61M, and 117N/T. Allele 13L of the  dhfr  gene and 553G of the  dhps  gene were not detected in any isolates examined in both studies. In the  dhfr  gene, tandem repeat type-A was the major tandem repeat observed in any isolates analysed. In the  dhps  gene, only the 383G allele was observed. Isolates carrying double, triple and quadruple mutants of  dhfr  gene were found in Lampung, Purworejo, Sumba, and Papua. Although this study revealed a wide distribution of  dhfr  and  dhps  alleles among the  P. vivax  isolates across a broad geographic regions in Indonesia, impact on SP efficacy was not observed in Sumba.    Conclusion  With proper malaria diagnosis, SP may still be used as a rational anti-malarial drug either as a single prescription or in combination with artemisinin.

Distribution of Plasmodium vivax pvdhfr and pvdhps alleles and their association with sulfadoxine–pyrimethamine treatment outcomes in Indonesia