Therapeutic efficacy and effects of artemisinin-based combination treatments on uncomplicated Plasmodium falciparum malaria-associated anaemia in Nigerian children during seven years of adoption as first-line treatments  

作　　者：Akintunde Sowunmi Kazeem Akano Godwin Ntadom Adejumoke I.Ayede Folasade O.Ibironke Temitope Aderoyeje Elsie O.Adewoye Bayo Fatunmbi Stephen Oguche Henrietta U.Okafor Ismaila Watila Martin Meremikwu Philip Agomo William Ogala Chimere Agomo Onikepe A.Folarin Grace O.Gbotosho Christian T.Happi 

机构地区：[1]Department of Pharmacology and Therapeutics,University of Ibadan,Ibadan,Nigeria [2]Institute for Medical Research and Training,College of Medicine,University of Ibadan,Ibadan,Nigeria [3]National Malaria Elimination Programme,Federal Ministry of Health,Abuja,Nigeria [4]Department of Paediatrics,University of Ibadan,Ibadan,Nigeria [5]Department of Clinical Pharmacology,University College Hospital,Ibadan,Nigeria [6]Department of Physiology,University of Ibadan,Ibadan,Nigeria [7]World Health Organization,Regional Office for the Western Pacific,Khan Daun Penh,Phnom Penh,Cambodia [8]Department of Paediatrics,University of Jos,Jos,Nigeria [9]Department of Paediatrics,Institute of Child Health,University of Nigeria Teaching Hospital,Enugu,Nigeria [10]Department of Paediatrics,Specialist Hospital,Maiduguri,Borno Sate,Nigeria [11]Department of Paediatrics,University of Calabar,Calabar,Cross Rivers State,Nigeria [12]Nigeria Institute of Medical Research,Yaba,Lagos,Nigeria [13]Department of Paediatrics,Ahmadu Bello University,Zaria,Nigeria [14]Department of Biological Sciences,Redeemer’s University,Ede,Osun State,Nigeria

出　　处：《Infectious Diseases of Poverty》2017年第1期315-334,共20页贫困所致传染病（英文）

基　　金：The efficacy studies from which the data were derived were supported by Swiss Pharma Nigeria PLC Grant to AS and by World Bank Malaria Booster Project,and Global Fund for Malaria to Federal Ministry of Health,Abuja,Nigeria through Drug Therapeutic Efficacy Testing in Nigeria;Logistic support for Drug Therapeutic Efficacy Testing was partly provided by Society for Family Health and Support for National Malaria Program(SunMap)in Nigeria。

摘　　要：Background:Artemisinin-based combination treatments(ACTs)are the first-line treatments of uncomplicated Plasmodium falciparum malaria in many endemic areas but there are few evaluation of their efficacy in anaemic malarious children.Methods:Therapeutic efficacy of 3-day regimens of artesunate-amodiaquine and artemether-lumefantrine was evaluated in 437 anaemic and 909 non-anaemic malarious children following treatment during a seven-year period(2008-2014).Patterns of temporal changes in haematocrit were classified based on haematocrit values<30%and≥30%.Kinetics of the disposition of the deficit in haematocrit from 30%following treatment were evaluated using a non-compartment model.Results:PCR-corrected parasitological efficacy 28 days after start of treatment was significantly higher in artesunateamodiaquine-compared to artemether-lumefantrine-treated children[97%(95%CI:92.8-100)versus 96.4%(95%CI:91.3-99.4),P=0.02],but it was similar in non-anaemic and anaemic children.Fall in haematocrit/1000 asexual parasites cleared from peripheral blood was significantly greater at lower compared to higher parasitaemias(P<0.0001),and in non-anaemic compared to anaemic children(P=0.007).In anaemic children at presentation,mean anaemia recovery time(AnRT)was 15.4 days(95%CI:13.3-17.4)and it did not change over the years.Declines in haematocrit deficits from 30%were monoexponential with mean estimated half-time of 1.4 days(95%CI:1.2-1.6).Anaemia half-time(t_(1/2anaemia))correlated positively with AnRT in the same patients(r=0.69,P<0.0001).Bland-Altman analysis of 10 multiples of t_(1/2anaemia) and AnRT showed narrow limit of agreement with insignificant bias(P=0.07)suggesting both can be used interchangeably in the same patients.Conclusions:Artesunate-amodiaquine and artemether-lumefantrine remain efficacious treatments of uncomplicated P.falciparum infections in non-anaemic and anaemic Nigerian children in the last 7 years of adoption as first-line treatments.These ACTs may also conserve haematocrit at high parasitaemias and

关 键 词：Malaria-associated anaemia “Haematocrit conservation” Artemisinin-based combination treatments Children Nigeria 

分 类 号：R53[医药卫生—内科学]