It is widely available throughout the continent and preliminary analysis has shown that the use of cotrimoxazole prophylaxis is a cost-effective intervention in Africa, particularly if combined with increased access to voluntary counselling and testing for HIV infection. The other challenge faced in deciding whether to recommend the use of cotrimoxazole in Africa is the risk of creating microbial resistance to the drug if it is widely utilised as a prophylactic. When patients in high-income countries develop infections resistant to a drug, alternatives are often available. This is not as true in Africa, where cotrimoxazole is one of the few affordable and widely available drugs recommended for common infectious illnesses such as pneumonias in children and bacterial diarrhoeas. The issue of resistance remains important to Africa's use of the drug.
Scientists are aware that using cotrimoxazole in Africa is only a medium-term solution.
Future research will therefore include investigation into alternative antimicrobial agents. In sub-Saharan Africa, where 23.3 million people live with HIV or AIDS, 13.7 million have already died because of the epidemic. In 1999 alone, there were 3.8 million new infections in the region.