Adherence to a six-dose regimen of artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Uganda
Adherence to a six-dose regimen of artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Uganda
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DOI：
10.4269/ajtmh.2004.71.525
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发表时间：
2004-11-01
影响因子：
3.3
通讯作者：
Guthmann, JP
中科院分区：
文献类型：
--
作者：
Fogg, C;Bajunirwe, F;Guthmann, JP
在采用新的抗疟药物之前，衡量坚持治疗的基线水平和查明不坚持治疗的风险因素是重要的步骤。在乌干达西南部的姆巴拉拉，我们评估了世界卫生组织最新的泡罩制剂中蒿甲醚-苯芴醇（Coartem（R））的依从性。患有无并发症恶性疟原虫疟疾的患者被处方蒿甲醚-苯芴醇，并获得如何在家中服用以下五剂的解释。在家庭访视期间进行片剂计数并完成问卷调查。在210例可分析患者中，21例（10.0%）明确或很可能为非依从性，而189例（90.0%）很可能为依从性。年龄组与依从性无关。在控制混杂因素后，缺乏正规教育是与不依从性相关的唯一因素（比值比3.1，95%置信区间[CI] = 1.1-9.7）。非粘附患者（n = 16）（2.76 μ g/mL，95%CI = 1.06-4.45）的平均本芴醇血药浓度低于粘附患者（n = 171）（3.19 μ g/mL，95%CI = 2.84-3.54），但差异无统计学意义。在我们的研究中发现，蒿甲醚-苯芴醇的高依从性表明，只要患者得到明确的剂量解释，这种药物在姆巴拉拉可能非常有效。
Measuring baseline levels of adherence and identifying risk factors for non-adherence are important steps before the introduction of new antimalarials. In Mbarara in southwestern Uganda, we assessed adherence to artemether-lumefantrine (Coartem(R)) in its latest World Health Organization blister formulation. Patients with uncomplicated Plasmodium falciparum malaria were prescribed artemether-lumefantrine and received an explanation of how to take the following five doses at home. A tablet count was made and a questionnaire was completed during a home visit. Among 210 analyzable patients, 21 (10.0%) were definitely or probably non-adherent, whereas 189 (90.0%) were probably adherent. Age group was not associated with adherence. Lack of formal education was the only factor associated with non-adherence after controlling for confounders (odds ratio 3.1, 95% confidence interval [CI] = 1.1-9.7). Mean lumefantrine blood levels were-lower among non-adherent (n = 16) (2.76 mug/mL, 95% CI = 1.06-4.45) than among adherent (n = 171) (3.19 mug/mL, 95% CI = 2.84-3.54) patients, but this difference was not statistically significant. The high adherence to artemether-lumefantrine found in our study suggest that this drug is likely to be very effective in Mbarara provided that patients receive clear dosage explanations.