The efficacy of sulfadoxine-pyrimethamine alone and in combination with chloroquine for malaria treatment in rural eastern Sudan: the interrelation between resistance, age and gametocytogenesis
The efficacy of sulfadoxine-pyrimethamine alone and in combination with chloroquine for malaria treatment in rural eastern Sudan: the interrelation between resistance, age and gametocytogenesis
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DOI：
10.1111/j.1365-3156.2006.01616.x
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发表时间：
2006-05-01
影响因子：
3.3
通讯作者：
Giha, HA
中科院分区：
文献类型：
--
作者：
A-Elbasit, IE;Elbashir, MI;Giha, HA
目的：比较磺胺多辛-除虫菊酯(SP)+氯喹(CQ)联合治疗与单用SP治疗恶性疟疾的疗效。方法：对苏丹东部农村半免疫人群中254例未合并恶性疟患者进行体内研究。结果：单用磺胺多辛-氯喹治疗治愈率为68.3%(41/60)，SP+氯喹治疗治愈率为63.4%(123/194)。两个治疗组均出现早期和晚期治疗失败。寄主年龄(作为免疫标志)和寄生虫配子体发生(作为传播性标志)与SP抗性显著相关。治愈的患者(中位年龄21岁)明显高于治疗失败的患者(中位年龄12岁)。治疗失败的患者配子体产量显著较高(0.72比0.45)，且与年龄较小有关。两组配子细胞计数在随访第7天之前是相似的；此后，治疗失败的患者配子细胞计数显著高于对照组。然而，两组配子细胞的寿命相似。结论：氯喹不能改善寄生虫对SP的反应。年龄与SP耐药寄生虫的清除密切相关。SP抗性的快速上升可能部分归因于SP抗性寄生虫的选择和通过SP的配子体形成效应扩大了抗性种群。
Objective: To compare the efficacy of sulfadoxine-pyremethamine (SP) + chloroquine (CQ) combination treatment against falciparum malaria with SP treatment alone.Method: In-vivo study of 254 patients with uncomplicated Plasmodium falciparum malaria in rural eastern Sudan, where the population is semi-immune.Results: Sulfadoxine-pyremethamine treatment alone cured 68.3% (41/60) and SP + CQ cured 63.4% (123/194). Early and late treatment failures occurred in both treatment groups. Host age (as a marker for immunity) and parasite gametocytogenesis (as a marker for transmissibility) were significantly associated with SP resistance. Patients who were cured were significantly older (median age 21 years) than patients whose treatment failed (median age 12 years). Gametocyte production was significantly higher in patients with treatment failure (0.72 vs 0.45) and associated with younger age. Gametocyte counts were comparable between both groups until day 7 of follow up; thereafter, they were significantly higher in patients with treatment failure. However, the longevity of gametocytes was comparable in both treatment groups.Conclusion: Chloroquine did not improve the parasite response to SP. Age was strongly associated with clearance of SP-resistant parasites. The fast rise of SP resistance may partially be due to selection of SP resistant parasites and expansion of the resistant population through the gametocytogenic effect of SP.