Low efficacy of amodiaquine or chloroquine plus sulfadoxine-pyrimethamine against Plasmodium falciparum and P. vivax malaria in Papua New Guinea
Low efficacy of amodiaquine or chloroquine plus sulfadoxine-pyrimethamine against Plasmodium falciparum and P. vivax malaria in Papua New Guinea
复制标题
DOI：
10.4269/ajtmh.2007.77.947
复制
发表时间：
2007-11-01
影响因子：
3.3
通讯作者：
Genton, Blaise
中科院分区：
文献类型：
--
作者：
Marfurt, Jutta;Mueeller, Ivo;Genton, Blaise
由于巴布亚新几内亚对 4-氨基喹啉类药物的耐药性不断增加，阿莫地喹 (AQ) 或氯喹 (CQ) 加磺胺多辛-乙胺嘧啶 (SP) 的联合疗法于 2000 年被引入作为对抗单纯性疟疾的一线疗法。本研究的目的是监测当前标准联合疗法对抗恶性疟原虫和间日疟原虫疟疾的体内疗效。 2003年至2005年期间，根据世界卫生组织（WHO）修订后的抗疟药物疗效评估方案，在巴布亚新几内亚的辛布省、东塞皮克省和马当省进行了研究。根据新的政策指南，对临床上明显且经寄生虫学证实的恶性疟或间日疟原虫疟疾的 6 个月至 7 岁儿童进行治疗（即，对体重 < 14 公斤的患者给予 AQ 加 SP，对体重≥ 14 公斤的患者给予 CQ 加 SP）。对儿童进行监测直至第28天，并根据临床和寄生虫学结果将其分类为充分的临床和寄生虫学反应（ACPR）、早期治疗失败（ETF）、晚期临床失败（LCF）或晚期寄生虫学失败（LPF）。对于恶性疟疾，截至第 28 天的聚合酶链反应 (PCR) 校正治疗失败率，AQ 加 SP 为 10.3% 至 28.8%，CQ 加 SP 为 5.6% 至 28.6%，具体取决于评估地区和年份。使用 AQ 或 CQ 加 SP 治疗间日疟原虫的总体治疗失败率为 12%。我们的结果表明巴布亚新几内亚目前的一线治疗效果不够。根据世界卫生组织新的疟疾治疗指南，该国两种主要疟疾物种的寄生虫耐药率超过10%，有理由改变治疗政策。
Because of increasing resistance to 4-aminoquinolines in Papua New Guinea, combination therapy of amodiaquine (AQ) or chloroquine (CQ) plus sulfadoxine-pyrimethamine (SP) was introduced as first-line treatment against uncomplicated malaria in 2000. The purpose of this study was to monitor in vivo efficacy of the current standard combination therapy against Plasmodium falciparum and P. vivax malaria. Studies were conducted between 2003 and 2005 in the Simbu, East Sepik, and Madang Provinces in Papaua New Guinea according to the revised protocol of the World Health Organization (WHO) for assessment of antimalarial drug efficacy. Children between six months and seven years of age with clinically overt and parasitologically confirmed P. falciparum or P. vivax malaria were treated according to the new policy guidelines (i.e., AQ plus SP given to patients weighing < 14 kg and CQ plus SP given to patients weighing ! 14 kg). Children were monitored up to day 28 and classified according to clinical and parasitological outcome as adequate clinical and parasitological response (ACPR), early treatment failure (ETF), late clinical failure (LCF), or late parasitological failure (LPF). For P. falciparum malaria, polymerase chain reaction (PCR)-corrected treatment failure rates up to day 28 ranged between 10.3% and 28.8% for AQ plus SP and between 5.6% and 28.6% for CQ plus SP, depending on the region and the year of assessment. Overall treatment failure rate with AQ or CQ plus SP for P. vivax malaria was 12%. Our results suggest that the current first-line treatment in Papua New Guinea is not sufficiently effective. According to the new WHO guidelines for the treatment of malaria, a rate of parasitological resistance greater than 10% in the two dominant malaria species in the country justifies a change in treatment policy.