Efficacy of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in northwest Cambodia
Efficacy of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in northwest Cambodia
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DOI：
10.1111/j.1365-3156.2006.01739.x
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发表时间：
2006-12-01
影响因子：
3.3
通讯作者：
Ringwald, Pascal
中科院分区：
文献类型：
--
作者：
Denis, Mey Bouth;Tsuyuoka, Reiko;Ringwald, Pascal
为了确定蒿甲醚-苯芴醇疟疾治疗的疗效，以替代青蒿琥酯+甲氟喹，后者在泰柬边境的一些地区逐渐无效，2002年和2003年在马德望省Sampov Lun转诊医院进行了两项研究，以监测蒿甲醚-苯芴醇的疗效。并于2003年进行了一项研究，以评估甲氟喹+青蒿琥酯的疗效，以供比较。这些研究根据WHO标准化方案进行，随访28天。疗效试验还辅以体外试验，并于2003年测量了接受蒿甲醚-本芴醇治疗的患者在第7天的本芴醇血浆浓度。2002年，55人接受蒿甲醚-苯芴醇治疗（AL 2002），2003年，80人服用蒿甲醚-苯芴醇和食物补充剂（AL 2003），55人服用青蒿琥酯+甲氟喹（AM 2003）。根据符合方案分析，研究AL 2002、研究AL 2003和研究AM 2003的治愈率分别为71.1%、86.5%和92.4%。所有数据均经PCR校正。2002年，蒿甲醚-苯芴醇的治愈率出乎意料地低，但2003年，随着食品补充，治愈率有所提高。有一个显着差异（P = 0.02），本芴醇血浆浓度之间的充分的临床和寄生虫学反应和治疗失败的情况下。本芴醇的体外敏感性降低了从治疗失败的患者中取样的分离株，但与从成功治疗的患者中取样的分离株的差异无统计学差异。蒿甲醚-本芴醇治疗失败的病例最有可能是因为本芴醇血药浓度低。有必要进一步调查，以确定该地区是否存在恶性疟原虫分离株对苯芴醇的耐药性。
To determine the efficacy of artemether-lumefantrine malaria treatment, as an alternative to artesunate + mefloquine, which is becoming ineffective in some areas of the Thai-Cambodian border.Two studies were conducted to monitor the efficacy of artemether-lumefantrine in Sampov Lun referral hospital, Battambang Province, in 2002 and 2003, and one study was conducted to assess the efficacy of mefloquine + artesunate in 2003 for comparison. The studies were performed according to the WHO standardized protocol with a follow-up of 28 days. The therapeutic efficacy tests were complemented with in vitro tests and in 2003, with the measurement of lumefantrine plasma concentration at day 7 for the patients treated with artemether-lumefantrine.A total of 190 patients were included: 55 were treated with artemether-lumefantrine in 2002 (AL2002), 80 with artemether-lumefantrine and food supplementation in 2003 (AL2003) and 55 with artesunate + mefloquine in 2003 (AM2003). With the per-protocol analysis, the cure rate was 71.1% in study AL2002, 86.5% in study AL2003 and 92.4% in study AM2003. All the data were PCR corrected. The artemether-lumefantrine cure rate was unexpectedly low in 2002, but it increased with food supplementation in 2003. There was a significant difference (P = 0.02) in lumefantrine plasma concentrations between adequate clinical and parasitological responses and treatment failure cases. In vitro susceptibility to lumefantrine was reduced for isolates sampled from patients presenting with treatment failure, but the difference was not statistically different from isolates sampled from patients who were successfully treated.Treatment failure cases of artemether-lumefantrine are most probably because of low levels of lumefantrine blood concentration. Further investigations are necessary to determine whether resistance of Plasmodium falciparum isolates to lumefantrine is present in the region.