Transactions of the Royal Society of Tropical Medicine and Hygiene Argemone mexicana decoction versus artesunate-amodiaquine for the management of malaria in Mali: policy and public-health implications
Transactions of the Royal Society of Tropical Medicine and Hygiene Argemone mexicana decoction versus artesunate-amodiaquine for the management of malaria in Mali: policy and public-health implications
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英国皇家热带医学和卫生学会会刊《墨西哥阿吉莫内煎剂与青蒿琥酯-阿莫地喹治疗马里疟疾的比较》：政策和公共卫生影响
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发表时间：
2009
期刊：
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通讯作者：
Drissa Dialloc
中科院分区：
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作者：
ertrand Graza;Merlin L. Willcoxa;Chiaka Diakiteb;J. Falqueta;lorent Dackuod;Oumar Sidibeb;Sergio Gianie;Drissa Dialloc
延缓耐药性的一个经典方法是在可能的情况下使用替代品。我们测试了治疗疟疾的Argemone mexicana汤（AM），这是一种经过验证的自制传统药物，由一种广泛使用的植物制成，在广泛的剂量变化中是安全的。为了反映马里一个偏远村庄疟疾家庭管理的真实的情况，301名假定无并发症疟疾患者（中位年龄5岁）被随机分配接受AM或青蒿素-阿莫地喹[青蒿素联合疗法（ACT）]作为一线治疗。两种治疗均耐受良好。在28天内，AM组89%（95%CI 84.1 -93.2）的患者不需要二线治疗，ACT组95%（95%CI 88.8-98.3）的患者不需要二线治疗。两组中≤ 5岁儿童病情恶化为严重疟疾的比例均为1.9%（> 5岁的住院患者均为0例），昏迷/惊厥发生率均为0%。AM现已在马里获得政府批准，可作为高传播地区标准现代药物的一线补充药物进行测试，以减少疟疾管理中对ACT耐药性的药物压力。鉴于严重疟疾的发病率较低且耐受性良好，AM也可能成为其他抗疟药物延迟获得时的急救治疗。
A classic way of delaying drug resistance is to use an alternative when possible. We tested the malaria treatment Argemone mexicana decoction (AM), a validated self-prepared traditional medicine made with one widely available plant and safe across wide dose variations. In an attempt to reflect the real situation in the home-based management of malaria in a remote Malian village, 301 patients with presumed uncomplicated malaria (median age 5 years) were randomly assigned to receive AM or artesunate-amodiaquine [artemisinin combination therapy (ACT)] as first-line treatment. Both treatments were well tolerated. Over28days,second-linetreatmentwasnotrequiredfor89%(95%CI84.1–93.2)ofpatients on AM, versus 95% (95% CI 88.8–98.3) on ACT. Deterioration to severe malaria was 1.9% in bothgroupsinchildrenaged ≤ 5years(therewerenocasesinpatientsaged>5years)and0% had coma/convulsions. AM, now government-approved in Mali, could be tested as a first- line complement to standard modern drugs in high-transmission areas, in order to reduce the drug pressure for development of resistance to ACT, in the management of malaria. In view of the low rate of severe malaria and good tolerability, AM may also constitute a first-aid treatment when access to other antimalarials is delayed.