旅游者疟疾化疗预防中的争议和误解
Lin H Chen1, Mary E Wilson, Patricia Schlagenhauf
1Travel Medicine Center, Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, MA 02238, USA. lchen@hms.harvard.edu
JAMA
|May 24, 2007
概括
疟疾化疗预防指导方针各不相同,而梅弗洛昆的安全性与其他药物相比相当. 普拉马奎因是有效的对抗Plasmodium vivax复发,但目前的指南缺乏共识.
科学领域:
- 热带医学和传染病
- 全球卫生与流行病学
- 药理学和药物安全问题
背景情况:
- 疟疾预防的争议源于数据缺口,相互矛盾的证据和不同的风险值.
- 关于疟疾严重程度,药物耐受性和驱逐剂有效性的误解,推动了预防辩论.
研究的目的:
- 为了比较国际疟疾化学预防指南,并确定建议中的差异.
- 审查梅弗洛的耐受性,重点关注神经精神效应和性能影响.
- 检查目前预防Plasmodium vivax疟疾复发的治疗方案的失败,并探索替代方案.
主要方法:
- 在2006年12月之前对MEDLINE/PubMed的系统文献搜索.
- 关键词包括疟疾,化疗预防,旅游,美弗洛,神经精神病学不良事件,耐受性,活性疟疾和普里马.
- 从选定的文章引用也被审查,没有语言限制.
主要成果:
- 目前的疟疾化学预防指导方针之间存在重大差距和冲突,涉及药物选择和预防持续时间.
- 有控制的研究表明,梅弗洛昆的严重神经精神病学不良事件发生率与其他药物相比,并且不会损害性能.
- 目前的一线化疗预防不能预防Plasmodium vivax复发,而普里马奎因在预防这些复发方面表现出有效性.
结论:
- 旅行者有效预防疟疾需要了解流行病学和宿主-寄生虫相互作用.
- 缺乏标准化的建议和持续的争议使疟疾预防策略复杂化.
- 国际共识对于协调指导方针,解决争议和改善遵守预防措施至关重要.
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