预防产后疟疾的青蒿素综合疗法：随机开放标签对照试验：预防产后疟疾。

IF 4.8 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Infectious Diseases Pub Date : 2024-10-11 DOI:10.1016/j.ijid.2024.107258

Paula Tesine , Sze-Ann Woon , Moses Laman , Gumul Yadi , Phantica Yambo , Bernadine Kasian , Lina Lorry , Leanne J. Robinson , Sam Salman , Kevin T. Batty , William Pomat , Laurens Manning , Wendy A. Davis , Timothy M.E. Davis , Brioni R. Moore

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引用次数: 0

摘要

目标：虽然疟疾流行地区的妇女产后疟疾发病率比非孕妇高，但还没有研究评估产后进行推定抗疟治疗的益处：虽然疟疾流行地区的妇女产后疟疾发病率比非孕妇高，但还没有研究评估产后进行假定性抗疟治疗的益处：方法：一项随机对照试验调查了抗疟治疗对预防产后疟疾的疗效，试验对象是巴布亚新几内亚的健康产妇。参与者按 1:1 随机分配接受无治疗（90 人）或青蒿素综合疗法（ACT），再按 1:1 随机分配接受蒿甲醚-本芴醇（AL，45 人）或双氢青蒿素-哌喹（DP，45 人）。每月进行一次标准化复查，为期六个月，包括临床评估、疟疾筛查和血红蛋白测量。主要终点是分娩后 6 个月内滑动片阳性疟疾的发生率：在招募的 183 名参与者中，有 151 人完成了研究程序，并纳入了按方案进行的分析（无治疗者 71 人，AL 者 40 人，DP 者 40 人）。与未接受治疗者相比，接受青蒿素综合疗法治疗者在6个月随访期间出现滑动片阳性疟疾的可能性明显降低（n=17 (21%) 对 n=27 (38%)；P=0-016；HR 0-49 (95% CI 0-27 to 0-90)）。两组 ACT 患者的疟疾发病率无明显差异：结论：分娩时接受一个疗程的青蒿素综合疗法可将产后前 6 个月的疟疾感染率降低一半。

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Artemisinin combination therapy at delivery to prevent postpartum malaria: A randomised open-label controlled trial

Objectives

Although the incidence of malaria is increased in women in endemic areas after delivery compared to non-pregnant women, no studies have assessed the benefit of presumptive antimalarial treatment given postpartum.

Methods

A randomised controlled trial investigating the efficacy of antimalarial treatment in preventing postpartum malaria was performed in healthy Papua New Guinea mothers immediately following delivery. Participants were randomised 1:1 to no treatment (n = 90) or artemisinin combination therapy (ACT), with further 1:1 ACT randomisation to artemether-lumefantrine (AL; n = 45) or dihydroartemisinin-piperaquine (DP; n = 45). Standardised reviews were conducted monthly for 6 months, including clinical assessment, malaria screening and haemoglobin measurement. The primary endpoint was incidence of slide-positive malaria within 6 months of delivery.

Results

Of 183 recruited participants, 151 completed study procedures and were included in per-protocol analyses (no treatment n = 71, AL n = 40, DP, n = 40). Those allocated to ACT were significantly less likely to develop slide-positive malaria during the 6-month follow-up period compared to those who were untreated (n = 17 (21%) vs n = 27 (38%); P = 0.016; hazard ratio 0.49 (95% confidence intervals 0.27-0.90). There was no significant difference in malaria incidence between the two ACT groups.

Conclusion

A treatment course of ACT at time of delivery halved the incidence of malaria infection during the first 6-month postpartum.

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来源期刊

International Journal of Infectious Diseases 医学-传染病学

CiteScore

18.90

自引率

2.40%

发文量

1020

审稿时长

30 days

期刊介绍： International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.