Ouldabdallahi Mohamed, Alew Ismail, Salem Mohamed Salem Ould Ahmedou, Dit Dialaw Ba Mamadou, Boukhary Ali Ould Mohamed Salem, Khairy Mohamed Lemine Ould, Aziz Mohamed Boubacar Abdel, Ringwald Pascal, Basco Leonardo K, Niang Saidou Doro, Lebatt Sid Mohamed
Unité de Recherche « Génsome et Milieux », Faculté des Sciences et Techniques, Université des Sciences, de Technologie et de Médecine, Nouakchott, Mauritania.
Malar J. 2014 Dec 16;13:496. doi: 10.1186/1475-2875-13-496.
A regular evaluation of therapeutic efficacy in sentinel sites and a system of surveillance are required to establish treatment guidelines and adapt national anti-malarial drug policy to the rapidly changing epidemiology of drug-resistant malaria. The current anti-malarial treatment guideline in Mauritania, officially recommended since 2006, is based on artemisinin-based combination therapy. The aim of the present study was to evaluate clinical efficacy and tolerance of artesunate-amodiaquine, the first-line treatment for acute uncomplicated malaria, in Mauritanian paediatric and adult patients to validate its continued use in the country.
Plasmodium falciparum-infected symptomatic patients aged > six months were enrolled in Kobeni and Timbedra in southern Mauritania in September to October 2013. Co-formulated artesunate-amodiaquine was administered at the recommended dose over three days. Patients were followed until day 28. Parasitological and clinical response was classified according to the standard 2009 World Health Organization protocol.
A total of 130 patients (65 in Kobeni and 65 in Timbedra) were enrolled in the study. Seventeen patients (13.1%) were either excluded (before PCR correction) or lost to follow-up. Based on the per protocol analysis, artesunate-amodiaquine efficacy (i.e., the proportion of adequate clinical and parasitological response) was 96.6% in Kobeni and 98.2% in Timbedra before PCR correction. Late clinical failure was observed in two patients in Kobeni and one patient in Timbedra. After PCR correction, the efficacy rate in the two study sites was 98.2%. On day 3, all patients were afebrile and had negative smears. Treatment was well tolerated.
Artesunate-amodiaquine is well tolerated and highly efficacious for the treatment of uncomplicated P. falciparum malaria. In the majority of patients, fever and parasitaemia were rapidly cleared before day 3. The results support the national anti-malarial drug guideline for a continued use of artesunate-amodiaquine as a first-line drug for uncomplicated malaria in southern Mauritania.
需要对哨点的治疗效果进行定期评估并建立监测系统，以制定治疗指南，并使国家抗疟药物政策适应耐药性疟疾迅速变化的流行病学情况。毛里塔尼亚自2006年起正式推荐的现行抗疟治疗指南以青蒿素联合疗法为基础。本研究的目的是评估青蒿琥酯-阿莫地喹（急性非复杂性疟疾的一线治疗药物）在毛里塔尼亚儿科和成人患者中的临床疗效及耐受性，以验证其在该国继续使用的合理性。
2013年9月至10月，在毛里塔尼亚南部的科贝尼和廷贝德拉招募了年龄大于6个月的恶性疟原虫感染的有症状患者。将复方青蒿琥酯-阿莫地喹按推荐剂量给药3天。对患者进行随访直至第28天。根据2009年世界卫生组织的标准方案对寄生虫学和临床反应进行分类。
共有130名患者（科贝尼65名，廷贝德拉65名）纳入研究。17名患者（13.1%）被排除（PCR校正前）或失访。根据符合方案分析，在PCR校正前，青蒿琥酯-阿莫地喹的疗效（即临床和寄生虫学充分反应的比例）在科贝尼为96.6%，在廷贝德拉为98.2%。在科贝尼有2名患者和廷贝德拉有1名患者出现晚期临床失败。PCR校正后，两个研究地点的有效率为98.2%。在第3天，所有患者均无发热且涂片阴性。治疗耐受性良好。
青蒿琥酯-阿莫地喹耐受性良好，对治疗非复杂性恶性疟原虫疟疾高度有效。在大多数患者中，发热和寄生虫血症在第3天前迅速清除。结果支持国家抗疟药物指南继续将青蒿琥酯-阿莫地喹用作毛里塔尼亚南部非复杂性疟疾的一线药物。
