Seasonal Malaria Chemoprevention Drug Levels and Drug Resistance Markers in Children With or Without Malaria in Burkina Faso: A Case-Control Study.
Seasonal Malaria Chemoprevention Drug Levels and Drug Resistance Markers in Children With or Without Malaria in Burkina Faso: A Case-Control Study.
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布基纳法索患有或不患有疟疾的儿童的季节性疟疾化学预防药物水平和耐药性标志物：病例对照研究。
DOI：
10.1093/infdis/jiad172
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Rosenthal,PhilipJ
中科院分区：
文献类型：
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作者：
Roh,MichelleE;Zongo,Issaka;Haro,Alassane;Huang,Liusheng;Somé,AnyirékunFabrice;Yerbanga,RakiswendéSerge;Conrad,MelissaD;Wallender,Erika;Legac,Jennifer;Aweeka,Francesca;Ouédraogo,Jean-Bosco;Rosenthal,PhilipJ
尽管在布基纳法索3-59个月的儿童中使用磺胺嘧啶-乙胺嘧啶和阿莫地喹（SP-AQ）的季节性疟疾化学预防（SMC）的规模扩大，但疟疾发病率仍然很高，引起了对SMC有效性和抗药性选择的关注。使用病例对照设计，我们确定SMC药物水平，耐药标志物，并介绍与malaria.MethodsWe招募了310名儿童在卫生设施在波波-迪乌拉索。病例是符合SMC资格的6-59个月的儿童，被诊断患有疟疾。每个病例入组两个对照组：符合SMC资格的无疟疾儿童;年龄较大（5-10岁）的无SMC资格的疟疾儿童。我们测量了SMC合格儿童的SP-AQ药物水平和寄生虫血症儿童的SP-AQ耐药标志物。条件Logistic回归计算比值比（OR）比较病例和controls.ResultsCompared药物水平之间的SMC合格的控制，疟疾儿童不太可能有任何可检测的SP或AQ（OR，0.33 [95%置信区间，.16-.67];P= .002），并有较低的药物水平（P< .05）。介导高水平SP耐药的突变的患病率是罕见的（0%-1%），病例和SMC不合格的对照组之间相似（P> 0.05）。结论SMC合格的儿童中的疟疾发病可能是由于SP-AQ的次优水平，导致错过周期，而不是增加抗疟药对SP-AQ的耐药性。
BackgroundDespite scale-up of seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine (SP-AQ) in children 3–59 months of age in Burkina Faso, malaria incidence remains high, raising concerns regarding SMC effectiveness and selection of drug resistance. Using a case-control design, we determined associations between SMC drug levels, drug resistance markers, and presentation with malaria.MethodsWe enrolled 310 children presenting at health facilities in Bobo-Dioulasso. Cases were SMC-eligible children 6–59 months of age diagnosed with malaria. Two controls were enrolled per case: SMC-eligible children without malaria; and older (5–10 years old), SMC-ineligible children with malaria. We measured SP-AQ drug levels among SMC-eligible children and SP-AQ resistance markers among parasitemic children. Conditional logistic regression was used to compute odds ratios (ORs) comparing drug levels between cases and controls.ResultsCompared to SMC-eligible controls, children with malaria were less likely to have any detectable SP or AQ (OR, 0.33 [95% confidence interval, .16–.67];P= .002) and have lower drug levels (P< .05). Prevalences of mutations mediating high-level SP resistance were rare (0%–1%) and similar between cases and SMC-ineligible controls (P> .05).ConclusionsIncident malaria among SMC-eligible children was likely due to suboptimal levels of SP-AQ, resulting from missed cycles rather than increased antimalarial resistance to SP-AQ.