Consideration of ethics in primaquine therapy against malaria transmission
Consideration of ethics in primaquine therapy against malaria transmission
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DOI：
10.1016/j.pt.2010.08.005
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发表时间：
2011-01-01
影响因子：
9.6
通讯作者：
Surjadjaja, Claudia
中科院分区：
文献类型：
--
作者：
Baird, J. Kevin;Surjadjaja, Claudia
数百万人接受伯喹治疗，以对抗导致疟疾传播的性疟原虫。这些配子体不会引起症状，也不会威胁宿主，但它们会感染蚊子并威胁社区。伯氨喹在少数葡萄糖-6-磷酸脱氢酶缺乏症（G6 PDd）患者中引起溶血。20世纪50年代的临床研究表明，在没有G6 PDd筛查的情况下，杀配子细胞伯氨喹是安全的。然而，评价的G6 PDd变体，非洲A-，对伯氨喹表现出轻度敏感性。伯氨喹作为一种安全的杀配子剂的观点主要基于对G6 PDd变体的观察，该变体不太可能挑战安全性。早期临床工作似乎无法充分评估G6 PDd患者的安全性。对患者无临床获益的潜在伤害风险提出了应审查的伦理问题。
Millions of people receive primaquine against sexual plasmodia responsible for malaria transmission. These gametocytes cause no symptoms and do not threaten the host, but they infect mosquitoes and threaten the community. Primaquine causes hemolysis in the small minority of patients with glucose-6-phosphate dehydrogenase deficiency (G6PDd). Clinical studies in the 1950s demonstrated gametocytocidal primaquine to be safe without G6PDd screening. However, the evaluated G6PDd variant, African A-, represents mild sensitivity to primaquine. The view of primaquine as a safe gametocytocide thus rests largely upon observations from a G6PDd variant that is unlikely to challenge safety. The early clinical work does not seem to afford an adequate assessment of safety in G6PDd patients. Potential risk of harm without clinical benefit to the patient raises ethical questions that should be examined.