马拉维布兰太尔地区对周效磺胺-乙胺嘧啶和甲氧苄啶-磺胺甲恶唑的严重皮肤反应

Severe cutaneous reactions to sulfadoxine-pyrimethamine and trimethoprim-sulfamethoxazole in Blantyre District, Malawi.

作者信息

Gimnig John E, MacArthur John R, M'bang'ombe Maurice, Kramer Michael H, Chizani Nyson, Stern Robert S, Mkandala Chris, Newman Robert D, Steketee Richard W, Campbell Carl H

机构信息

Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.

出版信息

Am J Trop Med Hyg. 2006 May;74(5):738-43.

PMID:16687672

Abstract

We estimated the frequency of clinically diagnosed Stevens-Johnson syndrome and toxic epidermal necrolysis associated with sulfadoxine-pyrimethamine (SP) and trimethoprim-sulfamethoxazole (CTX) in Blantyre District, Malawi. Cases were detected by passive surveillance at 22 health centers from March 2001 through September 2002. Denominators were estimated from the Malawi national census for Blantyre District and the frequency of SP and CTX use reported in five household surveys. Crude rates of adverse reactions were estimated to be 1.2 per 100,000 exposures for SP and 1.5 per 100,000 exposures for CTX. Rates were higher in adults (1.7 cases per 100,000 SP exposures and 2.6 cases per 100,000 CTX exposures) and in persons positive for human immunodeficiency virus (4.9 cases per 100,000 SP exposures and 8.4 cases per 100,000 CTX exposures). Infrequent treatment doses with SP are associated with a low risk of an adverse cutaneous reaction, and SP can be recommended for treatment of malaria in areas where P. falciparum is susceptible.

摘要

我们估算了在马拉维布兰太尔区，临床诊断的与磺胺多辛-乙胺嘧啶（SP）和复方新诺明（CTX）相关的史蒂文斯-约翰逊综合征及中毒性表皮坏死松解症的发生率。2001年3月至2002年9月期间，通过22个医疗中心的被动监测发现病例。分母数据根据马拉维全国人口普查中布兰太尔区的数据以及五次家庭调查中报告的SP和CTX使用频率估算得出。SP的不良反应粗发生率估计为每10万次暴露1.2例，CTX为每10万次暴露1.5例。成人中的发生率更高（SP每10万次暴露1.7例，CTX每10万次暴露2.6例），人类免疫缺陷病毒阳性者中的发生率也更高（SP每10万次暴露4.9例，CTX每10万次暴露8.4例）。SP的治疗剂量不高，发生皮肤不良反应的风险较低，在恶性疟原虫敏感地区，可推荐使用SP治疗疟疾。