Internal Medicine Department, Clínica Universidad de Navarra, Av, Pio XII 36, Pamplona 31008, Spain.
Malar J. 2013 May 7;12:153. doi: 10.1186/1475-2875-12-153.
The heterogeneity of malaria transmission makes widespread elimination a difficult goal to achieve. Most of the current vector control measures insufficiently target outdoor transmission. Also, insecticide resistance threatens to diminish the efficacy of the most prevalent measures, indoor residual spray and insecticide treated nets. Innovative approaches are needed. The use of endectocides, such as ivermectin, could be an important new addition to the toolbox of anti-malarial measures. Ivermectin effectively targets outdoor transmission, has a novel mechanism of action that could circumvent resistance and might be distributed over the channels already in place for the control of onchocerciasis and lymphatic filariasis.
The previous works involving ivermectin and Anopheles vectors are reviewed and summarized. A review of ivermectin's safety profile is also provided. Finally three definitive clinical trials are described in detail and proposed as the evidence needed for implementation. Several smaller and specific supportive studies are also proposed.
The use of ivermectin solves many challenges identified for future vector control strategies. It is an effective and safe endectocide that was approved for human use more than 25 years ago. Recent studies suggest it might become an effective and complementary strategy in malaria elimination and eradication efforts; however, intensive research will be needed to make this a reality.
疟疾传播的异质性使得广泛消除疟疾成为一个难以实现的目标。目前大多数的病媒控制措施都不能充分针对户外传播。此外，杀虫剂耐药性也威胁着最常见措施（室内滞留喷洒和经杀虫剂处理的蚊帐）的效果。需要采取创新方法。使用伊维菌素等驱虫药可能是抗疟措施工具包的一个重要新补充。伊维菌素能有效针对户外传播，具有一种新颖的作用机制，可以规避耐药性，而且可以通过已经存在的控制盘尾丝虫病和淋巴丝虫病的渠道进行分发。
回顾并总结了以前涉及伊维菌素和疟蚊媒介的研究。还提供了伊维菌素安全性概况的综述。最后详细描述了三项明确的临床试验，并提出了实施所需的证据。还提出了几项较小和特定的支持性研究。
使用伊维菌素解决了未来病媒控制策略中确定的许多挑战。它是一种经过 25 多年批准用于人类的有效且安全的驱虫药。最近的研究表明，它可能成为消除和消灭疟疾工作中的一种有效且互补的策略；然而，需要进行密集的研究才能使其成为现实。
