Comparative Efficacy of Artemether-Lumefantrine and Dihydroartemisinin-Piperaquine for the Treatment of Uncomplicated Malaria in Ugandan Children

被引:32
|
作者
Yeka, Adoke [1 ]
Wallender, Erika [5 ]
Mulebeke, Ronald [1 ]
Kibuuka, Afizi [1 ]
Kigozi, Ruth [2 ]
Bosco, Agaba [3 ]
Kyambadde, Paul [3 ]
Opigo, Jimmy [3 ]
Kalyesubula, Simeon [4 ]
Senzoga, Joseph [4 ]
Vinden, Joanna [6 ]
Conrad, Melissa [5 ]
Rosenthal, Philip J. [5 ]
机构
[1] Makerere Univ, Coll Hlth Sci, Sch Publ Hlth, Kampala, Uganda
[2] Malaria Consortium, Malaria Act Programme Dist, Kampala, Uganda
[3] Minist Hlth, Natl Malaria Control Program, Kampala, Uganda
[4] East African Publ Hlth Labs Networking Project, Kampala, Uganda
[5] Univ Calif San Francisco, Dept Med, Box 0811, San Francisco, CA 94110 USA
[6] Univ Calif Berkeley, Sch Publ Hlth, Berkeley, CA 94720 USA
来源
JOURNAL OF INFECTIOUS DISEASES | 2019年 / 219卷 / 07期
关键词
Treatment efficacy; malaria; artemether-lumefantrine; dihydroartemisinin-piperaquine; Uganda; PLASMODIUM-FALCIPARUM MALARIA; ARTEMISININ RESISTANCE; DRUG-SENSITIVITY; TEMPORAL TRENDS; MARKERS; POLYMORPHISMS; PARASITES; PREVALENCE; CAMBODIA;
D O I
10.1093/infdis/jiy637
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. In Uganda, artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DHA-PQ) showed excellent treatment efficacy for uncomplicated malaria in prior trials. Because the frequency of resistance to artemisinins and piperaquine is increasing in Southeast Asia and the prevalence of Plasmodium falciparum polymorphisms associated with resistance has changed, we reassessed treatment efficacies at 3 sites in Uganda. Methods. For this randomized, single-blinded clinical trial, children aged 6-59 months with uncomplicated falciparum malaria were assigned treatment with AL or DHA-PQ and followed for 42 days. Primary end points were risks of recurrent parasitemia, either unadjusted or adjusted to distinguish recrudescence from new infection. We assessed selection by study regimens of relevant P. falciparum genetic polymorphisms associated with drug resistance. Results. Of 599 patients enrolled, 578 completed follow-up. There were no early treatment failures. The risk of recurrent parasitemia was lower with DHA-PQ as compared to AL at all 3 sites at 42 days (26.0% vs 47.0%; P < .001). Recrudescent infections were uncommon in both the DHA-PQ and AL arms (1.1% and 2.2%, respectively; P = .25). Neither regimen selected for pfcrt or pfmdr1 polymorphisms associated with drug resistance. Conclusions. AL and DHA-PQ remain effective for the treatment of malaria in Uganda. Neither regimen selected for genetic polymorphisms associated with drug resistance.
引用
收藏
页码:1112 / 1120
页数:9
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