Osorio L E, Giraldo L E, Grajales L F, Arriaga A L, Andrade A L, Ruebush T K, Barat L M
Centro Internacional de Entrenamiento e Investigaciones Medicas, Cali, Colombia.
Am J Trop Med Hyg. 1999 Dec;61(6):968-72. doi: 10.4269/ajtmh.1999.61.968.
Although chloroquine (CQ) resistance was first reported in Colombia in 1961 and sulfadoxine-pyrimethamine (SP) resistance in 1981, the frequency of treatment failures to these drugs in Colombia is unclear. A modified World Health Organization 14-day in vivo drug efficacy test for uncomplicated Plasmodium falciparum malaria in areas with intense malaria transmission was adapted to reflect the clinical and epidemiologic features of a low-intensity malaria transmission area in the Pacific Coast Region of Colombia. Patients > or =1 year of age with a parasite density > or =1,000 asexual parasites per microliter were enrolled in this study. Forty-four percent (24 of 54) of the CQ-treated patients were therapeutic failures, including 7 early treatment failures (ETFs) and 17 late treatment failures (LTFs). Four (6%) of 67 SP-treated patients were therapeutic failures (2 ETFs and 2 LTFs). Therapeutic failure in the CQ-treated group was associated with an age <15 years old (P < 0.01), but was not associated with initial parasite density, the presence of CQ or sulfa-containing drugs in urine, or a history of malaria. The high level of therapeutic failures to CQ detected in this study underscores the need and importance of drug efficacy evaluation in the development of a rational national antimalarial drug policy. The relatively low level of therapeutic failures to SP compared with other South American countries raises further questions regarding factors that might have prevented the rapid development of in vivo resistance to this drug combination.
尽管1961年在哥伦比亚首次报告了对氯喹（CQ）的耐药性，1981年报告了对磺胺多辛-乙胺嘧啶（SP）的耐药性，但哥伦比亚这些药物治疗失败的频率尚不清楚。对世界卫生组织针对疟疾传播密集地区的非复杂性恶性疟原虫疟疾进行的14天体内药物疗效试验进行了修改，以反映哥伦比亚太平洋沿岸地区低强度疟疾传播地区的临床和流行病学特征。年龄≥1岁、寄生虫密度≥每微升1000个无性寄生虫的患者纳入本研究。接受CQ治疗的患者中有44%（54例中的24例）治疗失败，包括7例早期治疗失败（ETF）和17例晚期治疗失败（LTF）。接受SP治疗的67例患者中有4例（6%）治疗失败（2例ETF和2例LTF）。CQ治疗组的治疗失败与年龄<15岁相关（P<0.01），但与初始寄生虫密度、尿液中CQ或含磺胺药物的存在或疟疾病史无关。本研究中检测到的CQ治疗失败的高水平突出了在制定合理的国家抗疟药物政策时进行药物疗效评估的必要性和重要性。与其他南美国家相比，SP治疗失败的水平相对较低，这就引发了关于可能阻止对这种药物组合产生体内耐药性快速发展的因素的进一步问题。
