Predictors of chloroquine treatment failure in children and adults with falciparum malaria in Kampala, Uganda
Predictors of chloroquine treatment failure in children and adults with falciparum malaria in Kampala, Uganda
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DOI：
10.4269/ajtmh.2000.62.686
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发表时间：
2000-06-01
影响因子：
3.3
通讯作者：
Rosenthal, PJ
中科院分区：
文献类型：
--
作者：
Dorsey, G;Kamya, MR;Rosenthal, PJ
抗氯喹恶性疟疾是撒哈拉以南非洲大部分地区的一个严重问题。然而，希望继续使用氯喹作为无并发症疟疾的第一线疗法，其中氯喹在临床上仍然有效。为了确定氯喹治疗失败的预测因素，在乌干达的坎帕拉进行了一项为期14天的无并发症恶性疟疾患者对氯喹耐药性的临床研究。在258例患者中（88%随访），47%为临床失败（早期或晚期治疗失败），70%为寄生虫耐药（RI-RIII）。采用多变量分析，年龄小于5岁（比值比[OR] = 3.4，95%CI = 1.8-6.3）和体温超过38.0 ℃（OR = 2.0，95%CI = 1.1-3.7）是治疗失败的独立预测因素。此外，与最近（少于3天）或最近未使用氯喹的患者相比，在研究入组前最后服用氯喹3至14天的患者更有可能治疗失败。在氯喹耐药性严重的地区，可以使用容易识别的氯喹治疗失败的预测因子将患者分为氯喹使用可接受的患者和应使用替代治疗的患者。
Chloroquine-resistant falciparum malaria is a serious problem in much of sub-Saharan Africa. However, it is desirable to continue to use chloroquine as first line therapy for uncomplicated malaria where it remains clinically effective. To identify predictors of chloroquine treatment failure, a 14-day clinical study of chloroquine resistance in patients with uncomplicated falciparum malaria was performed in Kampala, Uganda. Among the 258 patients (88% follow-up), 47% were clinical failures (early or late treatment failure) and 70% had parasitological resistance (RI-RIII). Using multivariate analysis, an age less than five (odds ratio [OR] = 3.4, 95% CI = 1.8-6.3) and a presenting temperature over 38.0 degreesC (OR = 2.0, 95% CI = 1.1-3.7) were independent predictors of treatment failure. In addition, patients who last took chloroquine 3 to 14 days prior to study entry were significantly more likely to be treatment failures compared to patients with very recent (less than 3 days) or no recent chloroquine use. In areas with significant chloroquine resistance, easily identifiable predictors of chloroquine treatment failure might be used to stratify patients into those for whom chloroquine use is acceptable and those for whom alternative treatment should be used.