预防间日疟原虫疟疾复发的他非喹。

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拉贾帕克萨，罗德里戈C，费尔南多SD

预防间日疟原虫疟疾复发的他非喹。

Cochrane Database Syst Rev. 2015 Apr 29;(4):CD010458。cd010458.pub2 doi: 10.1002/14651858.。

PubMed ID
25921416 (PubMed视图
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摘要

背景:间日疟原虫疟疾广泛存在，持续的肝脏期会导致疾病复发，这有助于间日疟原虫的持续传播。伯氨喹是目前唯一治疗寄生虫肝期的药物，但需要14天才能有效，并且可能导致葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症患者溶血。此外，有一些证据表明寄生虫对这种药物有耐药性。他非喹是一种半衰期较长的新药物。目的:评价他非喹治疗间日疟原虫感染的疗效。必威国际app检索方法:我们检索了截至2015年4月13日的以下数据库:Cochrane传染病组专业登记册;Cochrane图书馆出版的Cochrane对照试验中央登记册(Central);MEDLINE;EMBASE;CINAHL; SCOPUS; and LILACS. We also searched the World Health Organization (WHO) International Clinical Trial Registry Platform and the metaRegister of Controlled Trials (mRCT) for ongoing trials using "tafenoquine" and "malaria" as search terms up to 13 April 2015. SELECTION CRITERIA: Randomized controlled trials (RCTs) in people with P. vivax malaria. Adverse effects of tafenoquine are assessed in populations where people with G6PD deficiency have been excluded, and in populations without screening for G6PD deficiency. DATA COLLECTION AND ANALYSIS: All review authors independently extracted data and assessed trial quality. Meta-analysis was carried out where appropriate, and estimates given as relative risk with 95% confidence intervals. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: Three RCTs met our inclusion criteria, with the asexual infection in both the tafenoquine and comparator arm treated with chloroquine, and in all trials G6PD deficiency patients were excluded. Tafenoquine dose comparisonsThree of the included trials compared eight different dosing regimens. Tafenoquine doses of 300 mg and above resulted in fewer relapses than no hypnozoite treatment over six months follow-up in adults (300 mg single dose: RR 0.19, 95% CI 0.08 to 0.41, one trial, 110 participants, moderate quality evidence; 500 to 600 mg single dose: RR 0.14, 95%CI 0.06 to 0.34, two trials, 122 participants, moderate quality evidence; 1800 mg to 3000 mg in divided doses: RR 0.05, 95% CI 0.01 to 0.23, two trials, 63 participants, low quality evidence).In people with normal G6PD status, there may be little or no difference in serious adverse events (three trials, 358 participants, low quality evidence); or any adverse event (one trial, 272 participants, low quality evidence). Tafenoquine versus primaquine Two of the included trials compared four different dosing regimens of tafenoquine against the standard primaquine regimen of 15 mg/day for 14 days. A single tafenoquine dose of 600 mg may be more effective than primaquine in relation to relapses at six months follow-up (RR 0.29, 95% CI 0.10 to 0.84, two trials, 98 participants, low quality evidence)In people with normal G6PD status, there may be little or no difference for serious adverse events (two trials, 323 participants, low quality evidence) or any adverse event (two trials, 323 participants, low quality evidence) between tafenoquine and primaquine. AUTHORS' CONCLUSIONS: Tafenoquine prevents relapses after clinically and parasitologically confirmed P. vivax malaria. The drug is untested in pregnancy, children and in G6PD-deficient people. The shorter treatment course is an important practical advantage in people who do not have G6PD deficiency, but the longer half-life may have more substantive consequences if given inadvertently to people with G6PD deficiency.

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