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Artenimol-piperaquine in children with uncomplicated imported falciparum malaria: experience from a prospective cohort.
Malaria Journal ( IF 3 ) Pub Date : 2019-12-16 , DOI: 10.1186/s12936-019-3047-9
Lauren Pull 1 , Jean-Marc Lupoglazoff 1 , Matthew Beardmore 2 , Jean-François Michel 1 , Pierre Buffet 3 , Olivier Bouchaud 4 , Jean-Yves Siriez 1
Affiliation  

BACKGROUND Although malaria remains one of the major public health threats in inter-tropical areas, there is limited understanding of imported malaria in children by paediatricians and emergency practitioners in non-endemic countries, often resulting in misdiagnosis and inadequate treatment. Moreover, classical treatments (atovaquone-proguanil, quinine, mefloquine) are limited either by lengthy treatment courses or by side effects. Since 2010, the World Health Organization (WHO) has recommended the use of oral artemisinin-based combination therapy for the treatment of uncomplicated Plasmodium falciparum malaria worldwide. The benefits of artenimol-piperaquine in children have been validated in endemic countries but experience remains limited in cases of imported malaria. METHODS This prospective observational study in routine paediatric care took place at the Emergency Department, Robert-Debré Hospital (Paris, France) from September 2012 to December 2014. Tolerance and efficacy of artenimol-piperaquine in children presenting with the following inclusion criteria were assessed: P. falciparum positive on thin or thick blood smear; and the absence of WHO-defined features of severity. RESULTS Among 83 children included in this study, treatment with artenimol-piperaquine was successful in 82 children (98.8%). None of the adverse events were severe and all were considered mild with no significant clinical impact. This also applied to cardiological adverse events despite a significant increase of the mean post-treatment QTc interval. CONCLUSION Artenimol-piperaquine displays a satisfying efficacy and tolerance profile as a first-line treatment for children with imported uncomplicated falciparum malaria and only necessitates three once-daily oral intakes of the medication. Comparative studies versus artemether-lumefantrine or atovaquone-proguanil would be useful to confirm the results of this study.

中文翻译:

单纯性恶性疟原虫患儿的青蒿琥酯:前瞻性队列研究的经验。

背景技术尽管疟疾仍然是热带地区主要的公共卫生威胁之一,但非流行国家的儿科医生和急诊医生对儿童输入性疟疾的了解有限,常常导致误诊和治疗不足。此外,经典的治疗方法(阿托伐醌-鸟嘌呤,奎宁,甲氟喹)受制于漫长的治疗过程或副作用。自2010年以来,世界卫生组织(WHO)建议在全球范围内使用基于青蒿素的口服联合疗法来治疗复杂的恶性疟原虫。流行病国家已验证了青蒿琥酯对儿童的益处,但在输入性疟疾病例中的经验仍然有限。方法这项前瞻性观察性常规儿童儿科研究于2012年9月至2014年12月在法国罗伯特-德布雷医院(法国巴黎)急诊室进行。评估了符合以下纳入标准的儿童对青蒿琥酯的耐受性和疗效:恶性疟原虫涂薄或浓血涂片阳性;并且没有WHO定义的严重性特征。结果本研究纳入的83名儿童中,有82名儿童(98.8%)接受了青蒿琥酯-哌喹治疗。没有一个不良事件是严重的,都被认为是轻度的,没有明显的临床影响。尽管平均治疗后QTc间隔显着增加,但这也适用于心脏病不良事件。结论Artenimol-piperaquine作为治疗输入性单纯性恶性疟疾患儿的一线治疗显示出令人满意的疗效和耐受性,并且仅需每天口服3次该药物。与蒿甲醚-荧光黄素或阿托喹酮-丙胍的比较研究将有助于证实该研究的结果。
更新日期:2019-12-16
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