Efficacy of Dihydroartemisinin-Piperaquine for Treatment of Uncomplicated Plasmodium falciparum and Plasmodium vivax in Cambodia, 2008 to 2010
Efficacy of Dihydroartemisinin-Piperaquine for Treatment of Uncomplicated Plasmodium falciparum and Plasmodium vivax in Cambodia, 2008 to 2010
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DOI：
10.1128/aac.00686-12
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发表时间：
2013-02-01
影响因子：
4.9
通讯作者：
Ringwald, Pascal
中科院分区：
文献类型：
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作者：
Leang, Rithea;Barrette, Amy;Ringwald, Pascal
我们在这里描述2008年至2010年在柬埔寨进行的抗疟疾治疗疗效研究的结果。使用治疗恶性疟原虫感染的双氢青蒿素-哌喹（DP）和治疗间日疟原虫感染的氯喹（CQ）和哌喹（DP）在4个哨点共进行了15项研究。所有研究都是根据世界卫生组织评估抗疟疾治疗效果的标准规程进行的。在DP治疗恶性疟原虫的研究中，西部省份的治疗失败率有所增加。2010年，pcr校正后的第42天DP治疗失败率在拜林为25%(95%可信区间[CI] = 10 - 51%)，在珀萨为10.7% (95% CI = 4 - 23%)，而在柬埔寨北部和东部的腊塔纳基里省和柏维夏省，DP的治疗效率仍然很高（100%）。对于间日疟原虫的研究，CQ治疗患者的28天未纠正治疗失败率从4.4到17.4%不等；DP在所有部位保持100%有效。需要进一步研究以调查柬埔寨西部疑似恶性疟原虫对哌喹的耐药性；体外和分子研究的结果没有发现支持治疗效果的发现。该区域出现的青蒿素耐药性可能对哌喹造成额外压力。虽然DP似乎是柬埔寨治疗间日疟的一种合适的新一线治疗方法，但柬埔寨西部的恶性疟原虫感染患者迫切需要其他治疗方法。
We describe here the results of antimalarial therapeutic efficacy studies conducted in Cambodia from 2008 to 2010. A total of 15 studies in four sentinel sites were conducted using dihydroartemisinin-piperaquine (DP) for the treatment of Plasmodium falciparum infection and chloroquine (CQ) and DP for the treatment of P. vivax infection. All studies were performed according to the standard World Health Organization protocol for the assessment of antimalarial treatment efficacy. Among the studies of DP for the treatment of P. falciparum, an increase in treatment failure was observed in the western provinces. In 2010, the PCR-corrected treatment failure rates for DP on day 42 were 25% (95% confidence interval [CI] = 10 to 51%) in Pailin and 10.7% (95% CI = 4 to 23%) in Pursat, while the therapeutic efficacy of DP remained high (100%) in Ratanakiri and Preah Vihear provinces, located in northern and eastern Cambodia. For the studies of P. vivax, the day 28 uncorrected treatment failure rate among patients treated with CQ ranged from 4.4 to 17.4%; DP remained 100% effective in all sites. Further study is required to investigate suspected P. falciparum resistance to piperaquine in western Cambodia; the results of in vitro and molecular studies were not found to support the therapeutic efficacy findings. The emergence of artemisinin resistance in this region has likely put additional pressure on piperaquine. Although DP appears to be an appropriate new first-line treatment for P. vivax in Cambodia, alternative treatments are urgently needed for P. falciparum-infected patients in western Cambodia.