Residual Antimalarial Concentrations before Treatment in Patients with Malaria from Cambodia: Indication of Drug Pressure
Residual Antimalarial Concentrations before Treatment in Patients with Malaria from Cambodia: Indication of Drug Pressure
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DOI：
10.1086/655779
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发表时间：
2010-10-01
影响因子：
6.4
通讯作者：
Ariey, Frederic
中科院分区：
文献类型：
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作者：
Hodel, Eva Maria;Genton, Blaise;Ariey, Frederic
背景过去30年来，泰柬边境一直被认为是抗疟药物耐药性的起源地。该地区的抗疟药物市场高度多样化，提高对药物压力的了解将有助于采取针对性干预措施，以减少不当药物使用。方法。采用液相色谱-串联质谱法，对125例恶性疟患者的基线样本进行了单次检测，分析了其中14种抗疟药物的存在情况。一半的患者在入院时至少有一种抗疟药的残留药物浓度高于校准下限。检测到的药物包括目前使用的一线药物甲氟喹（25%和35%的患者）和哌喹（15%的患者）;抗间日疟一线药物氯喹（25%和41%的患者）;以及以前的一线药物奎宁（5%和34%的患者）。调查结果表明，吸毒压力很大，许多人仍在私营和非正规部门寻求治疗，而这些部门不能保证得到适当的治疗。促进全面的行为改变、沟通、社区动员和宣传对于遏制寄生虫对新抗疟药物耐药性的出现和传播至关重要。
Background. The Thai-Cambodian border has been known as the origin of antimalarial drug resistance for the past 30 years. There is a highly diverse market for antimalarials in this area, and improved knowledge of drug pressure would be useful to target interventions aimed at reducing inappropriate drug use.Methods. Baseline samples from 125 patients with falciparum malaria recruited for 2 in vivo studies (in Preah Vihear and Pursat provinces) were analyzed for the presence of 14 antimalarials in a single run, by means of a liquid chromatography-tandem mass spectrometry assay.Results. Half of the patients had residual drug concentrations above the lower limit of calibration for at least 1 antimalarial at admission. Among the drugs detected were the currently used first-line drugs mefloquine (25% and 35% of patients) and piperaquine (15% of patients); the first-line drug against vivax malaria, chloroquine (25% and 41% of patients); and the former first-line drug, quinine (5% and 34% patients).Conclusions. The findings demonstrate that there is high drug pressure and that many people still seek treatment in the private and informal sector, where appropriate treatment is not guaranteed. Promotion of comprehensive behavioral change, communication, community-based mobilization, and advocacy are vital to contain the emergence and spread of parasite resistance against new antimalarials.