Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study
Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study
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DOI：
10.1186/1475-2875-11-214
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发表时间：
2012-06-22
期刊：
影响因子：
3
通讯作者：
McCarthy, James S.
中科院分区：
文献类型：
--
作者：
Townell, Nicola;Looke, David;McCarthy, James S.
背景：复发性间日疟原虫感染导致个体显著的发病率，并且是传播的关键因素。伯氨喹仍然是唯一获准用于预防复发的药物。为了最大限度地降低复发率，最近修订了治疗指南，建议增加伯氨喹剂量，目的是达到累积剂量>= 6 mg/kg，即70 kg患者>= 420 mg。本研究的目的是描述输入澳大利亚昆士兰州的间日疟原虫感染的流行病学特征，确定复发率，调查伯氨喹治疗的使用及其预防复发的有效性。对在昆士兰州的两个主要三级医院就诊的实验室确认的间日疟原虫感染进行回顾性研究，1999年1月至2011年1月在澳大利亚。伯氨喹给药分为无剂量、低剂量（= 420 mg）或未知。伯氨喹的剂量规定的患者谁随后复发，规定的患者谁没有relations.Results：20复发发生后，151间日疟原虫感染（13.2%）的主要事件。未服用伯氨喹、低剂量伯氨喹、高剂量伯氨喹和未知剂量伯氨喹的患者中分别有3/21（14.2%）、9/50（18.0%）、1/54（1.9%）和7/18（38.9%）例复发。高剂量伯氨喹治疗的复发率显著低于低剂量治疗的患者（OR 11.6，95%CI 1.5-519，p = 0.005）。结论：间日疟原虫感染复发在接受低剂量伯氨喹治疗的患者中更有可能。这项研究支持的建议，高剂量伯氨喹治疗是必要的，以尽量减少复发的间日疟。
Background: Relapsing Plasmodium vivax infection results in significant morbidity for the individual and is a key factor in transmission. Primaquine remains the only licensed drug for prevention of relapse. To minimize relapse rates, treatment guidelines have recently been revised to recommend an increased primaquine dose, aiming to achieve a cumulative dose of >= 6 mg/kg, i.e. >= 420 mg in a 70 kg patient. The aims of this study were to characterize the epidemiology of P. vivax infection imported into Queensland Australia, to determine the rates of relapse, to investigate the use of primaquine therapy, and its efficacy in the prevention of relapse.Methods: A retrospective study was undertaken of laboratory confirmed P. vivax infection presenting to the two major tertiary hospitals in Queensland, Australia between January 1999 and January 2011. Primaquine dosing was classified as no dose, low dose (= 420 mg), or unknown. The dose of primaquine prescribed to patients who subsequently relapsed that prescribed to patients who did not relapse.Results: Twenty relapses occurred following 151 primary episodes of P. vivax infection (13.2%). Relapses were confirmed among 3/21 (14.2%), 9/50 (18.0%), 1/54 (1.9%) and 7/18 (38.9%) of patients administered no dose, low dose, high dose and unknown primaquine dose respectively. High dose primaquine therapy was associated with a significantly lower rate of relapse compared to patients who were prescribed low dose therapy (OR 11.6, 95% CI 1.5-519, p = 0.005).Conclusions: Relapse of P. vivax infection is more likely in patients who received low dose primaquine therapy. This study supports the recommendations that high dose primaquine therapy is necessary to minimize relapse of P. vivax malaria.