Swiss Tropical Institute, Basel, Switzerland.
J Infect Dis. 2010 Oct 1;202(7):1088-94. doi: 10.1086/655779.
The Thai-Cambodian border has been known as the origin of antimalarial drug resistance for the past 30 years. There is a highly diverse market for antimalarials in this area, and improved knowledge of drug pressure would be useful to target interventions aimed at reducing inappropriate drug use.
Baseline samples from 125 patients with falciparum malaria recruited for 2 in vivo studies (in Preah Vihear and Pursat provinces) were analyzed for the presence of 14 antimalarials in a single run, by means of a liquid chromatography-tandem mass spectrometry assay.
Half of the patients had residual drug concentrations above the lower limit of calibration for at least 1 antimalarial at admission. Among the drugs detected were the currently used first-line drugs mefloquine (25% and 35% of patients) and piperaquine (15% of patients); the first-line drug against vivax malaria, chloroquine (25% and 41% of patients); and the former first-line drug, quinine (5% and 34% patients).
The findings demonstrate that there is high drug pressure and that many people still seek treatment in the private and informal sector, where appropriate treatment is not guaranteed. Promotion of comprehensive behavioral change, communication, community-based mobilization, and advocacy are vital to contain the emergence and spread of parasite resistance against new antimalarials.
过去 30 年来，泰柬边境地区一直被认为是抗疟药物耐药性的起源地。该地区存在着高度多样化的抗疟药物市场，提高对药物压力的认识对于针对减少不当药物使用的干预措施将是有用的。
对在柏威夏省和菩萨省进行的 2 项体内研究中招募的 125 例恶性疟原虫疟疾患者的基线样本进行了分析，采用液相色谱-串联质谱法在单次运行中检测了 14 种抗疟药物。
一半的患者入院时至少有 1 种抗疟药物的残留药物浓度高于校准下限。检测到的药物包括目前使用的一线药物甲氟喹（25%和 35%的患者）和哌喹（15%的患者）；治疗间日疟的一线药物氯喹（25%和 41%的患者）；以及以前的一线药物奎宁（5%和 34%的患者）。
这些发现表明存在高药物压力，并且许多人仍在私人和非正规部门寻求治疗，在这些部门无法保证得到适当的治疗。推广全面的行为改变、沟通、基于社区的动员和宣传，对于遏制新抗疟药物的寄生虫耐药性的出现和传播至关重要。
