Zuber Janie Anne, Takala-Harrison Shannon
Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
Infect Drug Resist. 2018 Mar 1;11:299-306. doi: 10.2147/IDR.S123887. eCollection 2018.
Based on the emergence and spread throughout the Greater Mekong Subregion (GMS) of multiple artemisinin-resistant lineages, the prevalence of multidrug resistance leading to high rates of artemisinin-based combination treatment failure in parts of the GMS, and the declining malaria burden in the region, the World Health Organization has recommended complete elimination of falciparum malaria from the GMS. Mass drug administration (MDA) is being piloted as one elimination intervention to be employed as part of this effort. However, concerns remain as to whether MDA might exacerbate the already prevalent problem of multidrug resistance in the region. In this review, we briefly discuss challenges of MDA, the use of MDA in the context of multidrug-resistant malaria, and the potential of different drug combinations and drug-based elimination strategies for mitigating the emergence and spread of resistance.
鉴于多种青蒿素抗性谱系在大湄公河次区域(GMS)出现并传播,导致该区域部分地区基于青蒿素的联合治疗失败率居高不下的多药耐药性普遍存在,以及该区域疟疾负担不断下降,世界卫生组织已建议在大湄公河次区域彻底消除恶性疟原虫疟疾。大规模药物管理(MDA)正在作为一项消除干预措施进行试点,作为这项工作的一部分加以采用。然而,对于MDA是否可能加剧该区域已经普遍存在的多药耐药性问题,人们仍然存在担忧。在这篇综述中,我们简要讨论了MDA面临的挑战、MDA在多药耐药性疟疾背景下的应用,以及不同药物组合和基于药物的消除策略在减轻耐药性出现和传播方面的潜力。