Chloroquine resistant Plasmodium falciparum malaria in Osogbo Nigeria: efficacy of amodiaquine + sulfadoxine-pyrimethamine and chloroquine + chlorpheniramine for treatment
Chloroquine resistant Plasmodium falciparum malaria in Osogbo Nigeria: efficacy of amodiaquine + sulfadoxine-pyrimethamine and chloroquine + chlorpheniramine for treatment
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DOI：
10.1590/s0074-02762008000100012
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发表时间：
2008-02-01
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影响因子：
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通讯作者：
Kolawole, SO
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作者：
Ogungbamigbe, TO;Ojurongbe, O;Kolawole, SO
在撒哈拉以南非洲，恶性疟原虫对氯喹（CQ）的抗药性导致了疟疾发病率和死亡率的增加.尽管药物政策发生了变化，但CQ的持续处方并未减少。因此，在尼日利亚西南部Osogbo的116名6至120个月的儿童中，采用标准的28天方案评估了CQ对无并发症恶性疟疾患者的治疗效果。对治疗反应的寄生虫学和临床评估显示，72例（62.1%）患者治愈，44例（37.9%）患者治疗失败。高初始寄生虫密度和年轻的年龄是早期治疗失败的独立预测因素。CQ治疗失败的44例患者中，24例接受阿莫地喹+磺胺嘧啶/乙胺嘧啶（AQ+ SP）治疗，20例接受扑尔敏+氯喹（CH+ CQ）联合治疗。AQ+ SP治疗组的平均退热时间与CH+ CQ治疗组无显著差异（p = 0.05）。两组的平均寄生虫密度无显著差异。AQ+ SP组治愈率为92%，CH+ CQ组治愈率为85%。两组间寄生虫清除时间存在显著差异（p = 0.01）。本研究报告的CQ治疗失败率为38%，高于世界卫生组织在其他抗疟治疗政策中建议的10%。因此，我们得出结论，CQ不能再单独依赖于治疗恶性疟疾在Osogbo，尼日利亚。AQ+ SP和CH+ CQ在治疗急性无并发症疟疾中是有效的，并且可以被认为是在缺乏基于青蒿素的联合疗法的情况下有用的替代药物。
Chloroquine ( CQ) resistance in Plasmodium falciparum contributes to increasing malaria- attributable morbidity and mortality in Sub- Saharan Africa. Despite a change in drug policy, continued prescription of CQ did not abate. Therefore the therapeutic efficacy of CQ in uncomplicated falciparum malaria patients was assessed in a standard 28- day protocol in 116 children aged between six and 120 months in Osogbo, Southwest Nigeria. Parasitological and clinical assessments of response to treatment showed that 72 ( 62.1%) of the patients were cured and 44 ( 37.9%) failed the CQ treatment. High initial parasite density and young age were independent predictors for early treatment failure. Out of the 44 patients that failed CQ, 24 received amodiaquine + sulphadoxine/ pyrimethamine ( AQ+ SP) and 20 received chlorpheniramine + chloroquine ( CH+ CQ) combinations. Mean fever clearance time in those treated with AQ+ SP was not significantly different from those treated with CH+ CQ ( p = 0.05). There was no significant difference in the mean parasite density of the two groups. The cure rate for AQ+ SP group was 92% while those of CH+ CQ was 85%. There was a significant difference in parasite clearance time ( p = 0.01) between the two groups. The 38% treatment failure for CQ reported in this study is higher than the 10% recommended by World Health Organization in other to effect change in antimalarial treatment policy. Hence we conclude that CQ can no more be solely relied upon for the treatment of falciparum malaria in Osogbo, Nigeria. AQ+ SP and CH+ CQ are effective in the treatment of acute uncomplicated malaria and may be considered as useful alternative drugs in the absence of artemisinin- based combination therapies.