Division of Parasitic Diseases and Malaria, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2011 Oct;53(8):772-9. doi: 10.1093/cid/cir498.
In 2007, Malawi replaced the first-line medication for uncomplicated malaria, sulfadoxine-pyrimethamine-a single-dose regimen-with artemether-lumefantrine (AL)-a 6-dose, 3-day regimen. Because of concerns about the complex dosing schedule, we assessed patient adherence to AL 2 years after routine implementation.
Adults and children with uncomplicated malaria were recruited at 3 health centers. We conducted both pill counts and in-home interviews on medication consumption 72 hours after patients received AL. Complete adherence was defined as correctly taking all 6 AL doses, as assessed by pill count and dose recall. We used logistic regression to identify factors associated with complete adherence.
Of 386 patients, 65% were completely adherent. Patients were significantly more likely to be completely adherent if they received their first dose of AL as directly observed therapy at the health center (odds ratio [OR], 2.4; P < .01), received instructions using the medication package as a visual aid (OR, 2.5; P = .02), and preferred AL over other antimalarials (OR, 2.7; P < .001). In contrast, children <5 years of age were significantly less likely to be adherent (OR, 0.5; P = .05).
Adherence to AL treatment for uncomplicated malaria was moderate, and children, who are the most likely to die of malaria, were less adherent than adults. Efforts to improve adherence should be focused on this vulnerable group. Interventions including the introduction of child-friendly antimalarial formulations, direct observation of the first dose, use of the AL package as a visual aid for instructions, and enhancing patient preference for AL could potentially increase AL adherence and overall effectiveness.
2007 年，马拉维将治疗无并发症疟疾的一线药物——磺胺多辛-乙胺嘧啶（一种单剂量疗程药物）更换为青蒿素-哌喹（一种 6 剂、3 天疗程药物）。由于担心复杂的用药方案，我们在常规使用青蒿素-哌喹 2 年后评估了患者的用药依从性。
在 3 家卫生中心招募患有无并发症疟疾的成人和儿童。在患者接受青蒿素-哌喹治疗后 72 小时，我们进行了药片计数和家访访谈，以评估其药物使用情况。完全依从是指根据药片计数和剂量回忆，正确服用所有 6 剂青蒿素-哌喹。我们使用逻辑回归来确定与完全依从相关的因素。
在 386 名患者中，65%的患者完全依从。如果患者在卫生中心接受直接观察治疗（直接观察治疗（DOT））（优势比[OR]，2.4；P <.01），接受用药方案作为视觉辅助的指导（OR，2.5；P =.02），并且更喜欢青蒿素-哌喹而不是其他抗疟药物（OR，2.7；P <.001），那么他们更有可能完全依从。相比之下，年龄 <5 岁的儿童明显不太可能依从（OR，0.5；P =.05）。
治疗无并发症疟疾的青蒿素-哌喹用药依从性中等，而最有可能死于疟疾的儿童比成人的依从性差。应将改善依从性的努力集中在这一脆弱群体上。潜在的干预措施包括引入适合儿童的抗疟药物制剂、直接观察第一剂药物、将青蒿素-哌喹用药方案用作指导的视觉辅助工具，以及增强患者对青蒿素-哌喹的偏好，这些措施可能会提高青蒿素-哌喹的依从性和整体效果。
