Calcutta School of Tropical Medicine, Kolkata, India.
Trop Med Int Health. 2011 Aug;16(8):929-35. doi: 10.1111/j.1365-3156.2011.02799.x. Epub 2011 May 12.
In India, till recently, Chloroquine was used as first-line therapy in areas with Chloroquine sensitive Plasmodium falciparum malaria cases. The National Vector Borne Disease Control Programme (NVBDCP) has introduced artemisinin combination therapy (ACT) as first-line option to treat all P. falciparum cases in the country. This study was carried out to ascertain the efficacy of Chloroquine and Sulphadoxine-Pyrimethamine, either alone or in combination, before the launch of ACT by NVBDCP.
A total of 300 P. falciparum malaria cases were enrolled randomly in three study arms, Chloroquine (CQ), Sulphadoxine-Pyrimethamine (SP) and Chloroquine plus Sulphadoxine-Pyrimethamine (CQ + SP). All patients were followed up for 28 days as per WHO (Assessment and Monitoring of Antimalarial Drug Efficacy for the Treatment of Uncomplicated Falciparum Malaria, Geneva, 2003) Protocol. Paired blood samples of treatment failure cases were collected and subjected to MSP 1, MSP 2 and GLURP genotyping for differentiation between re-infection and recrudescence. The data were analysed by Kaplan-Meier survival curve according to WHO standard procedures.
The overall failure rate including both early treatment failure (ETF) and late treatment failure (LTF) of CQ, SP and CQ + SP were 61%, 14% and 8%, respectively, in the study area. Of 60 recurrent malaria cases, genotyping was successful in 49 cases, revealing that most of the (46/49; 94%) cases of recurrent malaria were due to recrudescence.
In Jalpaiguri District the overall failure rate of CQ was 61% and of SP 14%, which was well above the WHO recommended cut-off threshold level (10%) for change of drug policy.
在印度，直到最近，氯喹仍被用于治疗对氯喹敏感的恶性疟原虫疟疾病例的一线疗法。国家媒介传播疾病控制规划（NVBDCP）已将青蒿素类复方疗法（ACT）作为治疗该国所有恶性疟原虫病例的一线选择。本研究旨在确定 NVBDCP 推出 ACT 之前，氯喹和磺胺多辛-乙胺嘧啶单独或联合使用的疗效。
共有 300 例恶性疟原虫疟疾患者随机分为三组，分别接受氯喹（CQ）、磺胺多辛-乙胺嘧啶（SP）和氯喹加磺胺多辛-乙胺嘧啶（CQ+SP）治疗。所有患者均按照世界卫生组织（日内瓦，2003 年，评估和监测抗疟药物治疗无并发症恶性疟原虫疟疾的疗效）方案进行 28 天的随访。对治疗失败的病例采集配对血样，并进行 MSP1、MSP2 和 GLURP 基因分型，以区分再感染和复发。根据世界卫生组织的标准程序，采用 Kaplan-Meier 生存曲线对数据进行分析。
包括早期治疗失败（ETF）和晚期治疗失败（LTF）在内，CQ、SP 和 CQ+SP 的总失败率在研究区域分别为 61%、14%和 8%。在 60 例复发性疟疾病例中，49 例成功进行了基因分型，结果表明，大多数（46/49；94%）复发性疟疾病例是由于复发引起的。
在 Jalpaiguri 区，CQ 的总失败率为 61%，SP 为 14%，这远远高于世界卫生组织建议的药物政策改变的临界阈值（10%）。
