Randomized Trial of Piperaquine with Sulfadoxine-Pyrimethamine or Dihydroartemisinin for Malaria Intermittent Preventive Treatment in Children 英文参考文献.docVIP

RandomizedTrialofPiperaquinewithSulfadoxine- PyrimethamineorDihydroartemisininforMalaria IntermittentPreventiveTreatmentinChildren BadaraCisse1,2,MatthewCairns2,ErnestFaye1,OusmaneNDiaye3,BabacarFaye1,CecileCames3 ,Yue Cheng4,MaguetteNDiaye2,AminataColle′Lo?2,KirstenSimondon3,Jean-FrancoisTrape3,OumarFaye2,5, JeanLouisNDiaye1,OumarGaye1,BrianGreenwood2,PaulMilligan2* 1DepartmentofParasitologyandMycology,UniversiteCheikhAntaDiop,Dakar,Senegal,2LondonSchoolofHygieneandTropicalMedicine,London,UnitedKingdom, 3InstitutdeRecherchepourleDeveloppement,Dakar,Senegal,4Xi’anJiaotongUniversityCollegeofMedicine,Xi’an,China,5MinisteredelaSante,Senegal Abstract Background:Thelongterminalhalflifeofpiperaquinemakesitsuitableforintermittentpreventivetreatmentformalaria butnostudiesofitsuseforpreventionhavebeendoneinAfrica.Wedidaclusterrandomizedtrialtodeterminewhether piperaquineincombinationwitheitherdihydroartemisin(DHA)orsulfadoxine-pyrimethamine(SP)isaseffective,andbetter tolerated, than SP plus amodiaquine (AQ), when used for intermittent preventive treatment in children delivered by communityhealthworkersinaruralareaofSenegal. Methods: Treatments were delivered to children 3–59 months of age in their homes once per month during the transmissionseasonbycommunityhealthworkers.33healthworkers,eachcoveringabout60children,wererandomizedto deliver either SP+AQ, DHA+PQ or SP+PQ. Primary endpoints were the incidence of attacks of clinical malaria, and the incidenceofadverseevents. Results: 1893 children were enrolled. Coverage of monthly rounds and compliance with daily doses was similar in all groups;90%ofchildrenreceived atleast2monthlydoses.PiperaquinecombinationswerebettertoleratedthanSP+AQ withasignificantlylowerriskofcommon,mildadverseevents.103episodesofclinicalmalariawererecordedduringthe courseofthetrial.68childrenhadmalariawithparasitaemia.3000/mL,29/671(4.3%)intheSP+AQgroup,comparedwith 22/604(3.6%)intheDHA+PQgroup(riskdifference0.47%,95%CI22.3%,+3.3%),and17/618(2.8%)int