Phần 2: Cập nhật thông tin về hiệu lực thuốc sốt rét artesunate-mefloquine trong điều trị sốt rét do Plasmodium falciparum đa kháng thuốc
Thuốc phối hợp Artesunate-mefloquine (ASMQ) đã chứng minh có hiệu quả, an toàn trong điều trị sốt rét do P. falciparum chưa biến chứng được khuyến cáo của TCYTTG (WHO, 2010) và được đánh giá công nhận lại (DNDi, 2012). Một nghiên cứu so sánh 4 loại thuốc do TCYTTG khuyến cáo chỉ ra ASMQ ức chế và làm giảm gánh nặng sốt rét tốt nhất. Hiệu lực lâm sàng của ASMQ đã được chứng minh tại nhiều quốc gia khác nhau, bao gồm cả Ấn Độ với trên 18.000 bệnh nhân trưởng thành điều trị loại thuốc này.
Việc công nhận như thế đã cho thấy thuốc ASMQ đã hội đủ các tiêu chuẩn của TCYTTG về chất lượng, an toàn và hiệu lực và điều trị rộng rãi tại châu Á như một trong 5 loại thuốc ACTs ưu tiên khuyến cáo dùng của TCYTTG. Vào năm 2009, một nghiên cứu tại Myanmar so sánh hiệu quả 4 loại thuốc ACTs do TCYTTG khuyến cáo thấy rằng ASMQ có tỷ lệ chữa khỏi cao nhất và tỷ lệ người mang giao bào thấp nhất, cung cấp bằng chứng giảm thiểu tối đa sự tái xuất hiện ký sinh trùng P. falciparum sau điều trị và ức chế hiệu quả nhất trên giai đoạn thể vô tính trong máu của P. vivax (DNDi, 2012).
Thuốc phối hợp liều ASMQđã chứng minh hiệu quả và tính an toàn trong điều trị sốt rét chưa biến chứng trên trẻ em nhỏ tại các quốc gia châu Phi với các kết quả thử nghiệm lâm sàng sốt rét cung cấp bằng chứng rằng chế phẩm ACTs này đã giúp cứu sống nhiều trẻ em châu Phi (DNDi, 2014) thông qua tại Hội nghị Y học Nhiệt đới và vệ sinh (American Society of Tropical Medicine and Hygiene- ASTMH, 2014 tại New Orland, Mỹ). Đây là một kết quả nghiên cứu đa trung tâm ở châu Phi bắt đầu từ năm 2008 để đánh giá hiệu lực và tính dung nạp thuốc ASMQ trên các trẻ em dưới 5 tuổi bị sốt rét chưa biến chứng do P. falciparum, kết quả chỉ ra rằng ASMQ an toàn và hiệu quả như thuốc artemether-lumefantrine (AL) đã từng được sử dụng tại châu Phi. Một nghiên cứu pha IV, nhãn mở, ngẫu nhiên, có đối chứn trên 945 trẻ em dưới 5 tuổi và theo dõi liệu trình 63 ngày. Liệu pháp ASMQ chỉ định dùng một lần mỗi ngày trong 3 ngày liên tiếp tại các quốc gia Burkina Faso, Kenya, Tanzania. Kết quả về hiệu lực dựa trên phân tích các chỉ số theo hướng dẫn của Tổ chức Y tế thế giới có hiệu chỉnh PCR của thuốc ASMQ là không hơn so với thuốc AL tại thời điểm ngày 28 với ASMQ là 97,5%/ AL là 94,6% và vào ngày D42 thì hiệu lực của ASMQ là 93,6%/ AL là 92,1% và vào ngày D6 thì hiệu lực ASMQ là 90,9%/AL là 89,7%. Không quan tâm đến tính dung nạp thuốc ASMQ hay AL, song có rất ít ca có biểu hiện buồn nôn, đặc biệt buồn nôn sớm, dẫn đến gián đoạn dùng thuốctrên cả hai phác đồ , không có tác dụng ngoại ý nào đáng kể được ghi nhận. Đồng thời, các dữ liệu về thuốc ASMQ (dạng không phối hợp liều) tại châu Phi trước đó đã cho thấy thuốc có hiệu lực cao, tính an toàn chấp nhận. Các dữ liệu lâm sàng nghiên cứu này bổ sung thêm vào hồ sơ về thuốc ASMQ dùng trên trẻ em được khuyến cáo của TCYTTG và được công nhận bởi tổ chức này.
Thuốc phối hợp liều ASMQ là một trong những thuốc ACT được khuyến cáo nhằm trì hoãn sự xuất hiện kháng thuốc đối với các thành phần thuốc trong phối hợp này. Liệu trình điều trị dễ chỉ định vì hai thuốc phối hợp trong một viên và chỉ đòi hỏi dùng liều 1 lần/ ngày trong 3 ngày (khi so sánh với thuốc AL dùng 2 lần mỗi ngày trong 3 ngày). Thuốc ASMQ đã chứng tỏ là một công cụ quan trọng và khuyến cáo bởi TCYTTG và giờ đây sẵn có loại thuốc dùng cho trẻ em tại châu Phi mắc sốt rét do P. falciparum chưa biến chứng. ASMQ dạng phối hợp liều giờ đây đã được đăng ký tại nhiều quốc gia như Brazil, Ấn Độ, Myanmar, Malaysia, Việt Nam, Tanzania và Niger và hiên đang làm thủ tục dăng ký tiếp tục tại 17 quốc gia châu Phi và châu Á (DNDi, 2014).
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Severe malaria presenting to the ED: A collaborative approach utilizing exchange transfusion and artesunate.
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