Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK.
Trends Parasitol. 2022 Aug;38(8):660-672. doi: 10.1016/j.pt.2022.05.008. Epub 2022 Jun 6.
Currently recommended methods of assessing the efficacy of uncomplicated falciparum malaria treatment work less well in high-transmission than in low-transmission settings. There is also uncertainty how to assess intermittent preventive therapies and seasonal malaria chemoprevention (SMC), and Plasmodium vivax radical cure. A pharmacometric antimalarial resistance monitoring (PARM) approach is proposed specifically for evaluating slowly eliminated antimalarial drugs in areas of high transmission. In PARM antimalarial drug concentrations at recurrent parasitaemia are measured to identify outliers (i.e., recurrent parasitaemias in the presence of normally suppressive drug concentrations) and to evaluate changes over time. PARM requires characterization of pharmacometric profiles but should be simpler and more sensitive than current molecular genotyping-based methodologies. PARM does not require parasite genotyping and can be applied to the assessment of both prevention and treatment.
目前评估无并发症恶性疟原虫病治疗效果的推荐方法在高传播地区的效果不如在低传播地区。对于间歇性预防治疗和季节性疟疾化学预防（SMC）以及间日疟根治也存在不确定性。提出了一种基于药物代谢动力学的抗疟药耐药性监测（PARM）方法，专门用于评估高传播地区消除缓慢的抗疟药物。在 PARM 中，测量复发性寄生虫血症时的抗疟药浓度，以确定异常值（即存在正常抑制药物浓度时的复发性寄生虫血症），并评估随时间的变化。PARM 需要对抗疟药药代动力学特征进行描述，但应该比目前基于分子基因分型的方法更简单、更敏感。PARM 不需要寄生虫基因分型，可用于评估预防和治疗。
