Triple co-administration of ivermectin, albendazole and praziquantel in zanzibar: a safety study.
Triple co-administration of ivermectin, albendazole and praziquantel in zanzibar: a safety study.
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DOI：
10.1371/journal.pntd.0000171
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发表时间：
2008-01-23
影响因子：
3.8
通讯作者：
Molyneux DH
中科院分区：
文献类型：
--
作者：
Mohammed KA;Haji HJ;Gabrielli AF;Mubila L;Biswas G;Chitsulo L;Bradley MH;Engels D;Savioli L;Molyneux DH
迄今为止，以分发防治淋巴丝虫病（LF）、盘尾丝虫病、土壤传播蠕虫病（STH）和血吸虫病的驱虫药为基础的公共卫生干预措施已分别实施。采取更加协调的方法来控制这种感染，可能有助于更好地利用现有资源，包括可能通过单一的大规模干预措施共同施用推荐的三种驱虫药物。在坦桑尼亚联合共和国桑给巴尔的一项旨在阐明和量化可能副作用的试点干预中，对生活在LF、STH和血吸虫病流行地区的5055名儿童和成人联合施用伊维菌素、阿苯达唑和吡喹酮。随后，在一项针对桑给巴尔大部分人口的全国性干预中，这些药物被共同施用于约70万人。在两种干预措施期间进行的被动和主动监测措施表明，同时给予三种药物的副作用是轻度和自限性事件。我们的数据表明，在淋巴丝虫病、土壤传播性蠕虫病和血吸虫病共同流行的地区，以及过去使用一种或两种药物进行几轮治疗的地区，伊维菌素、阿苯达唑和吡喹酮联合给药是安全的。但是，应继续采取被动监测措施，并将发现、管理和报告可能的副作用视为任何给药保健干预措施的关键组成部分。这篇论文描述了在大规模药物分配规划中分别使用的三种药物在一起使用时如何在以前分别使用相同药物治疗的大量人群（Mectizan[伊维菌素]、阿苯达唑和吡喹酮）中显得安全。目标疾病——淋巴丝虫病、土壤传播蠕虫和血吸虫病——在2000年之前在桑给巴尔流行，但已在很大程度上通过大规模药物管理得到控制。卫生和社会福利部在世卫组织的支持下，最初在两个地点对5000多人进行了三联疗法的小规模试验，发现没有与联合治疗相关的严重不良事件，然后扩大规模，对70多万符合条件的全部人口进行治疗。同样，没有严重的不良事件。这是这三种药物首次在非洲同时大规模使用，并为扩大蠕虫的综合预防性化疗提供了基础。接下来的步骤需要在蠕虫负荷较重的种群中开始，此类干预措施需要受到密切监测和伦理审查。
Public health interventions based on distribution of anthelminthic drugs against lymphatic filariasis (LF), onchocerciasis, soil-transmitted helminthiasis (STH) and schistosomiasis have been implemented separately to date. A better use of available resources might be facilitated by a more coordinated approach to control such infections, including the possibility of co-administering the three recommended anthelminthic drugs through a single, large-scale intervention. Ivermectin, albendazole and praziquantel were co-administered to 5,055 children and adults living in areas endemic for LF, STH and schistosomiasis in Zanzibar, United Republic of Tanzania, during a pilot intervention aimed at elucidating and quantifying possible side-effects. Subsequently, these drugs were co-administered to about 700,000 individuals during a countrywide intervention targeting a large part of the total population of Zanzibar. Passive and active surveillance measures carried out during both interventions showed that side-effects attributable to the three drugs given at the same time were mild and self-limiting events. Our data suggest that co-administration of ivermectin, albendazole and praziquantel is safe in areas where lymphatic filariasis, soil-transmitted helminthiasis and schistosomiasis are co-endemic and where several rounds of treatment with one or two drugs have been implemented in the past. Passive surveillance measures, however, should be continued and detection, management and reporting of possible side-effects should be considered a key component of any health intervention administering drugs. This paper describes how the use of three drugs which are used separately in mass drug distribution programmes when given together appear safe for use in large populations which have been previously treated with the same drugs separately (Mectizan [ivermectin], albendazole and praziquantel). The target diseases—lymphatic filariasis, soil-transmitted worms and schistosomiasis—were prevalent in Zanzibar up to 2000 but have been largely controlled by mass drug administration. The Ministry of Health and Social Welfare, with the support of WHO, initiated a small scale trial in a population of triple therapy in over 5,000 people initially in two sites, and having found there were no severe adverse events associated with the combined treatment then upscaled to treat the whole of the eligible population of over 700,000. Similarly, there were no severe adverse events. This is the first time the three drugs have been used together at the same time at scale in Africa and provide a basis for expansion of integrated preventive chemotherapy of helminths (worms). The next steps need to be initiated in populations which have heavier worm loads and such interventions need to be subject to close monitoring and ethical review.
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DOI：
10.1016/s0035-9203(01)90034-3
发表时间：
2001-09-01
影响因子：
2.2
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