A Standardised Protocol for Evaluation of Anthelminthic Efficacy 英文参考文献.docVIP

ExpertCommentary AStandardisedProtocolforEvaluationofAnthelminthic Efficacy JohnHorton* ThePaddock,Hitchin,UnitedKingdom Althoughtheconceptoftargetedorcommunity-widetreatment for soil-transmitted helminths (STHs) is not new, having been initiatedoriginallybytheRockefellerSanitaryCommissioninthe United States [1,2] and more recently supported by Warren [3] andotherssome30yearsagoasafeasibleapproach,itisonlyin thelast10years,sincetheWorldHealthAssemblyresolution[4], that helminth control has become a reality. Today there are a numberofglobalinitiatives,suchastheGlobalProgrammeforthe EliminationofFilariasisandtheSchistosomiasisControlInitiative, where anthelminthics form a large part of the structure of mass treatmentprogrammes.Inaddition,themovetowardsintegrated programmes and a number of different drug interventions has meantthat,atlast,alargeportionoftheglobalpopulationatrisk isbeingtreated.Thiswasfurtheraugmentedin2010byadditional large donations from GlaxoSmithKline [5] and Johnson Johnson[6],sothatinthenearfuturealmostonequarterofthe global populationmay betreated each yearwith anthelminthics. However,fortheSTHs,asforschistosomiasis,theseinterventions are based on a very limited drug armamentarium. There is thereforeaveryrealriskthatwidespreadusemayengenderdrug resistanceandputtheprogrammesatrisk.Thus,itisimperative that active monitoring is undertaken to detect, and hopefully respond to, the first signs of drug resistance. While the genetic changes associated with drug resistance to the most widely used drugs forSTHs,thebenzimidazolecarbamates, albendazoleand mebendazole,arewellunderstood,activescreeningusinggenetic markersisprobablyimpracticalotherthanforconfirmationofits occurrence.Therefore,monitoringofdrugefficacyinthefieldis, and will probably remain, the tool of choice for the foreseeable future. considered to be a key measure of efficacy, egg reduction is of greaterimportanceinSTHcontrol,becausetheaimistoreduce infection,ratherthantoeliminateit,since