Plowe C V, Djimde A, Wellems T E, Diop S, Kouriba B, Doumbo O K
Department of Medicine, University of Maryland School of Medicine, Baltimore, USA.
Am J Trop Med Hyg. 1996 Nov;55(5):467-71. doi: 10.4269/ajtmh.1996.55.467.
Pyrimethamine-sulfadoxine (PS, Fansidar; Hoffman-LaRoche, Basel, Switzerland) is now the first-line antimalarial therapy in parts of Africa with high rates of chloroquine-resistant Plasmodium falciparum. With PS resistance increasing and no suitably inexpensive and effective third antimalarial drug available, strategies for delaying the spread of PS resistance in Africa are needed. Community PS usage was measured in two Malian villages, one rural and one periurban, and prevalence of pyrimethamine-resistant P. falciparum genotypes was determined at these sites and two urban sites. The prevalence of resistant genotypes was 22.6% (n = 84) in the periurban village where PS was available from multiple sources and large stocks of PS were observed, and 13.5% (n = 89) and 23.4% (n = 77) in a large town and a city, respectively, where PS is widely available. No pyrimethamine-resistant genotypes (n = 58) were detected in Kolle, a rural village with a community-supported dispensary and clinic where PS is used sparingly and no PS was available in pharmacies or markets. The high rates of pyrimethamine resistant genotypes concurrent with higher PS usage argue for a policy of judicious PS use in Mali and in similar settings. A possible model for slowing the spread of drug-resistant malaria is illustrated by the example of the Kolle clinic.
乙胺嘧啶-磺胺多辛（PS，Fansidar；瑞士巴塞尔霍夫曼-罗氏公司）目前是非洲部分地区对氯喹耐药恶性疟原虫感染率较高时的一线抗疟治疗药物。随着PS耐药性增加且没有合适的廉价有效第三抗疟药物可用，需要制定在非洲延缓PS耐药性传播的策略。在马里的两个村庄（一个是农村村庄，一个是城郊村庄）对社区PS使用情况进行了测量，并在这些地点以及两个城市地点确定了对乙胺嘧啶耐药的恶性疟原虫基因型的流行情况。在城郊村庄，PS可从多个来源获取且观察到有大量PS库存，耐药基因型的流行率为22.6%（n = 84）；在PS广泛可得的一个大城镇和一个城市，耐药基因型的流行率分别为13.5%（n = 89）和23.4%（n = 77）。在科勒，一个有社区支持的药房和诊所的农村村庄，PS使用较少且药房或市场没有PS，未检测到对乙胺嘧啶耐药的基因型（n = 58）。乙胺嘧啶耐药基因型的高流行率与较高的PS使用量同时出现，这表明在马里及类似环境中应采取明智使用PS的政策。科勒诊所的例子说明了一个减缓耐药疟疾传播的可能模式。
