Effect of intermittent treatment with amodiaquine on anaemia and malarial fevers in infants in Tanzania: a randomised placebo-controlled trial
Effect of intermittent treatment with amodiaquine on anaemia and malarial fevers in infants in Tanzania: a randomised placebo-controlled trial
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DOI：
10.1016/s0140-6736(03)13504-0
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发表时间：
2003-05-31
期刊：
影响因子：
168.9
通讯作者：
Bygbjerg, IC
中科院分区：
文献类型：
--
作者：
Massaga, JJ;Kitua, AY;Bygbjerg, IC
背景疟疾是撒哈拉以南非洲地区婴儿发病和死亡的主要原因之一，并且经常并发严重贫血。恶性疟原虫对大多数负担得起的抗疟药物的耐药性是间歇化疗的一个障碍。我们在坦桑尼亚的一个完全流行地区调查了婴儿阿莫地喹间歇性治疗和每日补充铁对疟疾发烧和贫血的影响，该地区的疟疾在很大程度上对氯喹和周效磺胺/乙胺嘧啶具有耐药性。方法291名在三个诊所就诊的12-16周婴儿被随机分配接受阿莫地喹、铁补充剂、阿莫地喹加铁补充剂或安慰剂。在6个月内，我们给阿莫地喹三次，间隔60天;每天口服补铁。疟疾发热和贫血进行了监测，在每两个月的治疗访问和自我报告的健康centers.Findings-在预防疟疾发热和贫血的间歇阿莫地喹治疗的保护效果分别为64.7%（95%CI，42.4-77-2）和67.0%（95%CI，34.5-83.4）。阿莫地喹加补铁组的保护效果相似。仅接受铁补充的婴儿可部分预防贫血（保护效力59.8%; 95%CI，23.4-78.9），但不能预防疟疾热。术后随访4个月，无反跳发生。我们注意到没有血液学或临床不良反应。解释假定间歇治疗疟疾阿莫地喹减少疟疾发烧和贫血的婴儿，在一个地区与其他抗疟药物的高耐药性。在疟疾高度流行的地区，对疟疾采取间歇性治疗战略可能对公共卫生大有好处。
Background Malaria is a major cause of infant morbidity and mortality in sub-Saharan Africa, and is often complicated by severe anaemia. Resistance of Plasmodium falciparum to most affordable antimalarial drugs is an impediment to intermittent chemotherapy. We investigated the effect of presumptive intermittent treatment with amodiaquine and daily iron supplementation in infants on malarial fevers and anaemia, in a holoendemic area of Tanzania where malaria is largely resistant to chloroquine and sulfadoxine/ pyrimethamine.Methods 291 infants aged 12-16 weeks who attended three clinics were randomised to receive amodiaquine, iron supplementation, amodiaquine plus iron supplementation, or placebo. Over 6 months, we gave amodiaquine three times with intervals of 60 days; oral iron supplementation was given daily. Malarial fevers and anaemia were monitored at bimonthly treatment visits and by self-reporting to health centres.Findings The protective efficacy of intermittent amodiaquine treatment in prevention of malarial fevers and anaemia was 64.7% (95% Cl, 42.4-77-2) and 67.0% (95% Cl, 34.5-83.4), respectively. Protective efficacy was similar in the group receiving amodiaquine plus iron supplementation. Infants receiving iron supplementation only were partly protected against anaemia (protective efficacy 59.8%; 95% Cl, 23.4-78.9), but not against malarial fevers. 4 months' follow-up did not show rebound morbidity. We noted no haematological or clinical adverse effects.Interpretation Presumptive intermittent treatment for malaria with amodiaquine reduced malarial fevers and anaemia in infants, in an area with high resistance to other antimalarials. Intermittent treatment strategies for malaria in highly endemic areas could be of great benefit to public health.