Ogouyèmi-Hounto Aurore, Azandossessi Christian, Lawani Souliatou, Damien Georgia, de Tove Yolande Sissinto Savi, Remoue Franck, Kinde Gazard Dorothée
Unité d'Enseignement et de Recherche en Parasitologie Mycologie/Faculté des Sciences de la Santé, laboratoire du Centre de Lutte intégrée contre le paludisme, 01 BP188, Cotonou, Benin.
Laboratoire du Centre de Lutte intégrée contre le paludisme, 01 BP188, Cotonou, Benin.
Malar J. 2016 Jan 22;15:37. doi: 10.1186/s12936-016-1091-2.
Artemether/lumefantrine (Coartem(®)) has been used as a treatment for uncomplicated Plasmodium falciparum infection since 2004 in Benin. This open-label, non-randomized study evaluated efficacy of artemether-lumefantrine (AL) in treatment of uncomplicated falciparum malaria in children aged 6-59 months in two malaria transmission sites in northwest Benin.
A 42-day therapeutic efficacy study was conducted between August and November 2014, in accordance with 2009 WHO guidelines. One-hundred and twenty-three children, aged 6 months to 5 years, with uncomplicated falciparum malaria were recruited into the study. The primary endpoint was parasitological cure on day 28 and day 42 while the secondary endpoints included: parasite and fever clearance, improvement in haemoglobin levels. Outcomes were classified as early treatment failure (ETF), late clinical failure, late parasitological failure, and adequate clinical and parasitological response (ACPR).
Before PCR correction, ACPR rates were 87% (95 % CI 76.0-94.7) and 75.6%, respectively (95% CI 67.0-82.9) on day 28 and day 42. In each study site, ACPR rates were 78.3% in Djougou and 73% in Cobly on day 42. There was no ETF and after PCR correction ACPR was 100% in study population. All treatment failures were shown to be due to new infections. Fever was significantly cleared in 24 h and approximately 90% of parasites where cleared on day 1 and almost all parasites were cleared on day 2. Haemoglobin concentration showed a slight increase with parasitic clearance.
AL remains an efficacious drug for the treatment of uncomplicated falciparum malaria in Benin, although higher rates of re-infection remain a concern. Surveillance needs to be continued to detect future changes in parasite sensitivity to artemisinin-based combination therapy.
自2004年以来，蒿甲醚/本芴醇（科泰复（®））一直在贝宁用于治疗非复杂性恶性疟原虫感染。这项开放标签、非随机研究评估了蒿甲醚-本芴醇（AL）在贝宁西北部两个疟疾传播地点治疗6至59个月儿童非复杂性恶性疟的疗效。
2014年8月至11月期间，根据2009年世界卫生组织指南进行了一项为期42天的治疗效果研究。123名6个月至5岁的非复杂性恶性疟儿童被纳入该研究。主要终点是第28天和第42天的寄生虫学治愈情况，次要终点包括：寄生虫清除和发热消退、血红蛋白水平改善。结果分为早期治疗失败（ETF）、晚期临床失败、晚期寄生虫学失败以及充分的临床和寄生虫学反应（ACPR）。
在进行PCR校正之前，第28天和第42天的ACPR率分别为87%（95%CI 76.0 - 94.7）和75.6%（95%CI 67.0 - 82.9）。在每个研究地点，第42天朱古的ACPR率为78.3%，科比的为73%。没有出现ETF情况，在进行PCR校正后，研究人群中的ACPR率为100%。所有治疗失败均显示是由于新感染所致。发热在24小时内显著消退，约90%的寄生虫在第1天被清除且几乎所有寄生虫在第2天被清除。血红蛋白浓度随寄生虫清除略有增加。
在贝宁，AL仍然是治疗非复杂性恶性疟的有效药物，尽管再感染率较高仍是一个问题。需要继续进行监测，以发现寄生虫对青蒿素联合疗法敏感性的未来变化。
