Chloroquine treatment for uncomplicated childhood malaria in an area with drug resistance:: early treatment failure aggravates anaemia
Chloroquine treatment for uncomplicated childhood malaria in an area with drug resistance:: early treatment failure aggravates anaemia
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DOI：
10.1016/s0035-9203(98)90913-0
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发表时间：
1998-09-01
影响因子：
2.2
通讯作者：
Björkman, A
中科院分区：
文献类型：
--
作者：
Ekvall, H;Premji, Z;Björkman, A
儿童贫血是疟疾大流行地区的一个主要公共卫生问题。我们应用 1996 年世界卫生组织体内方法评估社区一级标准氯喹治疗，评估了耐药恶性疟疾地区抗疟治疗对幼儿血红蛋白水平的影响。在坦桑尼亚沿海的 Fukayosi 村，117 名 5-36 个月大的临床疟疾儿童接受了氯喹糖浆（25 毫克/公斤）治疗。 20% 的病例发生早期治疗失败 (ETF)，22% 的病例发生晚期治疗失败 (LTF)。年龄>1岁和营养不良是ETF的保护因素。氯喹治疗无法预防贫血恶化的证据是：(i) ETF 组 72 小时后血红蛋白水平下降明显大于 LTF 且临床反应充分的儿童；(ii) 单独接受氯喹治疗的儿童在随访时没有任何血液学改善，即使治疗真正成功。相比之下，治疗失败后使用乙胺嘧啶/磺胺多辛可在治疗开始后 21 天以上显着改善血红蛋白水平（平均差异 14 g/L，95% 置信区间 2.1-27）。我们的结论是，当氯喹治疗儿童疟疾与 20% ETF 率相关时，血红蛋白反应不令人满意，需要改变推荐的一线治疗。
Childhood anaemia is a major public health problem in malaria holoendemic areas. We assessed the effects of antimalarial treatment in an area with drug-resistant falciparum malaria on haemoglobin levels in small children by applying the 1996 World Health Organization in vivo method for the evaluation of standard chloroquine treatment at the community level. In Fukayosi village, coastal Tanzania, 117 children aged 5-36 months with clinical malaria episodes were treated with chloroquine syrup (25 mg/kg). Early treatment failure (ETF) occurred in 20% and late treatment failure (LTF) in 22% of cases. Age >1 year and malnutrition were protective factors against ETF. The evidence that chloroquine treatment could not prevent an exacerbation of anaemia was (i) the fact that the fall in haemoglobin level after 72 h was significantly greater in ETF than in children with LTF and an adequate clinical response, and (ii) the absence of any haematological improvement at follow-up in children receiving chloroquine alone, even in true treatment successes. In contrast, pyrimethamine/sulfadoxine administered to treatment failures improved the haemoglobin level significantly >21 d after treatment started (mean difference 14 g/L, 95% confidence interval 2.1-27). We conclude that, when chloroquine treatment of childhood malaria is associated with a 20% ETF rate, the haemoglobin response is unsatisfactory and there is a need to change the recommended first-line treatment.