Reduction of malaria transmission to Anopheles mosquitoes with a six-dose regimen of co-artemether
Reduction of malaria transmission to Anopheles mosquitoes with a six-dose regimen of co-artemether
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DOI：
10.1371/journal.pmed.0020092
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发表时间：
2005-04-01
期刊：
影响因子：
15.8
通讯作者：
Targett, GAT
中科院分区：
文献类型：
--
作者：
Sutherland, CJ;Ord, R;Targett, GAT
背景 在非洲，疟疾寄生虫对氯喹（CQ）和磺胺多辛-乙胺嘧啶（SP）的耐药性正在增加。如果联合疗法能够抑制携带抗性基因的寄生虫的传播，那么它既可以改善治疗效果，又可以提供重要的公共健康益处。因此，必须确定药物组合，以最大限度地减少治疗病例中配子体的出现，从而防止对任何伙伴药物耐药的寄生虫的选择性传播。 方法和结果在一项随机对照试验中，497 名患有无并发症的恶性疟疾的儿童接受了 CQ 和 SP（分别为 3 剂和 1 剂；n = 91）或 6 剂蒿甲醚与本芴醇（辅蒿甲醚 [复方蒿甲醚，复方蒿甲醚，里亚梅]）（n = 406）。治疗后7、14和28天测量恶性疟原虫配子细胞和滋养体的携带率。采用按蚊膜饲法检测29例携带恶性疟配子体的儿童治疗7 d后静脉血的传染性。与接受 CQ/SP 治疗的儿童相比，接受共蒿甲醚治疗的儿童在治疗后 4 周内携带配子细胞的可能性显着降低（378 名儿童中有 30 名 [7.94%] 对比 86 名儿童中有 42 名 [48.8%]；p < 0.0001）。与接受 CQ/SP 的携带者相比，联合蒿甲醚组中的携带者配子体密度明显较低，持续时间较短（0.3 天与 4.2 天；p < 0.0001），并且在第 7 天对蚊子的传染性较低（p < 0.001）。结论 联合蒿甲醚在预防恶性疟原虫治疗后传播方面非常有效。我们的结果表明，辅蒿甲醚对未成熟的隔离配子细胞具有特异性活性，并且能够最大程度地减少耐药寄生虫的传播。
Background Resistance of malaria parasites to chloroquine (CQ) and sulphadoxine-pyrimethamine (SP) is increasing in prevalence in Africa. Combination therapy can both improve treatment and provide important public health benefits if it curbs the spread of parasites harbouring resistance genes. Thus, drug combinations must be identified which minimise gametocyte emergence in treated cases, and so prevent selective transmission of parasites resistant to any of the partner drugs.Methods and Findings In a randomised controlled trial, 497 children with uncomplicated falciparum malaria were treated with CQ and SP (three doses and one dose respectively; n = 91), or six doses of artemether in fixed combination with lumefantrine (co-artemether [Coartem, Riamet]) (n = 406). Carriage rates of Plasmodium falciparum gametocytes and trophozoites were measured 7, 14, and 28 d after treatment. The infectiousness of venous blood from 29 children carrying P. falciparum gametocytes 7 d after treatment was tested by membrane-feeding of Anopheles mosquitoes. Children treated with co-artemether were significantly less likely to carry gametocytes within the 4 weeks following treatment than those receiving CQ/SP (30 of 378 [7.94%] versus 42 of 86 [48.8%]; p < 0.0001). Carriers in the co-artemether group harboured gametocytes at significantly lower densities, for shorter periods (0.3 d versus 4.2 d; p < 0.0001) and were less infectious to mosquitoes at day 7 (p < 0.001) than carriers who had received CQ/SP.Conclusions Co-artemether is highly effective at preventing post-treatment transmission of P. falciparum. Our results suggest that co-artemether has specific activity against immature sequestered gametocytes, and has the capacity to minimise transmission of drug-resistant parasites.