Kilian A H, Jelinek T, Prislin I, Kabagambe G, Byamukama W, Mpigika G, Korte R, von Sonnenburg F
GTZ Basic Health Services Western Uganda, Fort Portal, Uganda.
Trans R Soc Trop Med Hyg. 1998 Mar-Apr;92(2):197-200. doi: 10.1016/s0035-9203(98)90748-9.
In the context of the 'integrated management of childhood illnesses' (IMCI) programme the World Health Organization recommends treating children in malarious areas presenting with fever and respiratory symptoms with co-trimoxazole. In order to verify its effectiveness in uncomplicated Plasmodium falciparum malaria we carried out a study in vivo in western Uganda: 180 children under 5 years old were enrolled and treated with 40/8 mg/kg/d co-trimoxazole over 5 d, and 159 could be followed on days 3, 7 and 14. Effectiveness of treatment was found to be significantly different in various parts of the study area. In Bundibugyo District, bordering République Democratique du Congo (Zaire), 59.1% (39/66) of children were clinically cured after 14 d and 56.1% were parasitologically cured. In the east of Kabarole District (43 children), the figures were 76.7% and 65.1%, respectively. In western Kabarole (50 children) the rates were 96.0% and 90.0%, respectively. We conclude that, in view of the high level of clinical failures in parts of the study area, co-trimoxazole should not be used in the IMCI programme for combined treatment of malaria and pneumonia in the region. Assessment of therapeutic effectiveness of antimalarial drugs needs to consider the microepidemiology of resistance.
在“儿童疾病综合管理”（IMCI）项目背景下，世界卫生组织建议对疟疾流行地区出现发热和呼吸道症状的儿童使用复方新诺明进行治疗。为了验证其在非复杂性恶性疟原虫疟疾中的有效性，我们在乌干达西部进行了一项体内研究：招募了180名5岁以下儿童，给予40/8mg/kg/d复方新诺明治疗，持续5天，其中159名儿童在第3、7和14天可进行随访。研究发现，治疗效果在研究区域的不同地方存在显著差异。在与刚果民主共和国（扎伊尔）接壤的本迪布焦区，14天后59.1%（39/66）的儿童临床治愈，56.1%的儿童寄生虫学治愈。在卡巴罗莱区东部（43名儿童），这两个数字分别为76.7%和65.1%。在卡巴罗莱西部（50名儿童），治愈率分别为96.0%和90.0%。我们得出结论，鉴于研究区域部分地区临床治疗失败率较高，在该区域的IMCI项目中不应使用复方新诺明联合治疗疟疾和肺炎。抗疟药物治疗效果的评估需要考虑耐药性的微观流行病学。
