Using evidence to change antimalarial drug policy in Kenya
Using evidence to change antimalarial drug policy in Kenya
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DOI：
10.1046/j.1365-3156.2000.00643.x
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发表时间：
2000-11-01
影响因子：
3.3
通讯作者：
Snow, RW
中科院分区：
文献类型：
--
作者：
Shretta, R;Omumbo, J;Snow, RW
氯喹抗药性于1978年首次在肯尼亚发现，并在20世纪80年代升级。氯喹仍然是治疗无并发症疟疾感染的首选药物，直到1998年修订的指南发布，尽管有大量的科学证据表明它失败了。本审查分析的范围和质量的证据基础，用于改变药物政策，在肯尼亚从氯喹SP和检查过程中的共识建设和决策。我们的审查表明，在转换的敏感性数据与总的地理，时间和方法的变化到国民待遇政策的困难。由于选择有限、替代疗法的不良影响未知、成本以及对改变疟疾药物政策相关因素的指导有限，这一过程变得复杂。尽管到1995年，超过50%的研究显示寄生虫学失败，但在评估药物失败的原则、研究对象的纳入标准以及寄生虫学和临床评估的相对益处方面普遍缺乏共识。1996年，国际药物疗效评估建议从寄生虫学改为临床反应，这进一步困扰了决策。迫切需要制定国际标准和循证准则，以提供一个框架，协助疟疾流行国家的决策者作出合理选择，改变抗疟药物政策。
Chloroquine resistance was first detected in Kenya in 1978 and escalated during the 1980s. Choroquine remained the treatment of choice for uncomplicated malaria infections until revised guidelines were launched in 1998 despite a plethora of scientific evidence on failure. This review analyses the range and quality of the evidence base that was used to change the drug policy in Kenya from chloroquine to SP and examines the process of consensus building and decision making. Our review illustrates the difficulties in translating sensitivity data with gross geographical, temporal and methodological variations into national treatment policy. The process was complicated by limited options, unknown adverse effects of replacement therapies, cost, as well as limited guidance on factors pertinent to changing the drug policy fox malaria. Although > 50% of the studies showed parasitological failures by 1995, there was a general lack of consensus on the principles for assessing drug failures, the inclusion criteria for the study subjects and the relative benefits of parasitological and clinical assessments. A change in international recommendations for assessment of drug efficacy in 1996 from parasitological to clinical response further perplexed the decisions. There is an urgent need for international standards and evidence-based guidelines to provide a framework to assist the process by which decision-makers in malaria-endemic countries can make rational choices for antimalarial drug policy change.