Singapore Armed Force stops use of usual anti-malaria drug

Maloprim is now no longer handed out to Singapore soldiers ahead of training in mosquito-infested areas here or overseas.

Since April last year, two alternative drugs have been used instead.

The soldier at the heart of this change was recruit Muhammad Sufian Jamil, 18, who died on Feb 1 last year of blood poisoning and multi-organ failure after taking several doses of Maloprim between December 2005 and January last year.

The State Coroner yesterday recorded a verdict of misadventure on his death, and found that the recruit had been given adequate medical care from when he fell ill until his death.

|Between 20,000 and 30,000 soldiers have taken the drug every year since 1985 without fatalities.

Mr Sufian enlisted on Dec 3, 2005 and was sent for basic military training at Pulau Tekong Camp.

Unknown to him or anyone then, he had Dapsone hypersensitivity syndrome (DHS), a severe allergic reaction to Dapsone, an ingredient in Maloprim.

In a 2004 study done here by the Academy of Science, which cited three cases of servicemen who survived DHS, the authors warned that it could appear like a virus-like illness and include a delayed-onset rash.

Mr Sufian sought medical treatment six times on Pulau Tekong for symptoms such as cough, fever, muscle pain and headache - which suggested a flu-like illness.

It was only 37 days after the first dose of Maloprim that a rash - a more conclusive symptom of DHS - arose.

He sought treatment at Alexandra Hospital on Jan 15 and was given drugs and calamine lotion for the fever and rash.

Eight days later, he turned up at the hospital again and was moved to the National University Hospital for rash, fever, jaundice and acute liver failure.

He never got better. Multi-organ failure set in and he died nine days later.

Associate Professor Chow Wan Cheng, the head and senior consultant of the department of gastroenterology and hepatology at Singapore General Hospital, said in his report that the doctors at both hospitals had managed Mr Sufian appropriately.

Another expert, consultant dermatologist Lim Kah Beng, said this was a rare case of DHS.

Given that the rash appeared 37 days after the first dose of Maloprim and 22 days after the onset of flu-like symptoms, it might have been difficult to link the rash to a drug allergy, said Dr Lim.

Colonel Dr Benjamin Seet, the chief army medical officer, said after Mr Sufian's death, the SAF took immediate steps to, among other things, educate SAF doctors on the condition and sent all its stocks of Maloprim for tests.

Col Benedict Lim, the Mindef spokesman, said Mindef and the SAF were saddened by Mr Sufian's death and offered condolences to his family.

At Mr Sufian's family home in Jurong West, the mood on the day of the coroner's hearing was sombre.

Said delivery driver Jamil Mustapa, Mr Sufian's 50-year-old father, who deliberately gave the hearing a miss: 'It was fate that took Sufian away and we've continued with our lives.'

He has two sons - one aged 21, who just completed his national service with the police force, and another in Secondary Three.

He added: 'I don't blame anyone for Sufian's death. It was God's wish and we can only accept it.' 

The Straits Times/Asia News Network