Association of failures of seven-day courses of artesunate in a non-immune population in Bangui, Central African Republic with decreased sensitivity of Plasmodium falciparum
Association of failures of seven-day courses of artesunate in a non-immune population in Bangui, Central African Republic with decreased sensitivity of Plasmodium falciparum
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DOI：
10.4269/ajtmh.2005.73.616
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发表时间：
2005-09-01
影响因子：
3.3
通讯作者：
Talarmin, A
中科院分区：
文献类型：
--
作者：
Menard, D;Matsika-Claquin, MD;Talarmin, A
我们对生活在中非共和国班吉的55名非免疫患者进行了为期7天的青蒿琥酯治疗无并发症恶性疟原虫疟疾的疗效和安全性评估。第14、28、42天的寄生虫治愈率分别为100%、95%和85%。痊愈患者与复发患者的寄生密度、双氢青蒿素50%抑制浓度、突变型恶性疟原虫多药耐药1密码子86频率均无显著差异。然而，在复发患者中，双氢青蒿素90%的抑制浓度和分离的基因型数量都更高（分别为5倍和2倍）。我们发现复发和敏感性降低之间存在联系。这表明单独使用青蒿素化合物将选择耐药菌株。我们的结论是，青蒿琥酯不应用于单一治疗，即使是7天疗程，而应与其他抗疟疾药物联合使用，以防止耐药恶性疟原虫的出现。
We assessed the efficacy and safety of a seven-day course of artesunate for the treatment of uncomplicated Plasmodium falciparum malaria in 55 non-immune patients living in Bangui, Central African Republic. The parasitologic cure rates were 100%, 95%, and 85% on days 14, 28, and 42, respectively. There were no significant differences in parasitemia density, 50% inhibitory concentration of dihydroartemisinin, and frequency of mutant P. falciparum multidrug resistance 1 codon 86 between patients who were cured and those who displayed recrudescence. However, the 90% inhibitory concentration for dihydroartemisinin and the number of genotypes isolated were both higher in the recrudescent patients (five- and two-fold, respectively). We found an association between recrudescence and decreased sensitivity. This suggests that the use of artemisinin compounds alone will select resistant strains. We conclude that artesunate should not be used in monotherapy even in seven-day courses, but only in combination with other anti-malarials to prevent the emergence of resistant P. falciparum.