期刊
JOURNAL OF INFECTIOUS DISEASES
卷 207, 期 11, 页码 1646-1654出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jit078
关键词
malaria; pharmacokinetics; piperaquine; artemisinin combination therapy; antimalarial
资金
- Doris Duke Charitable Foundation [2007055]
- Department of Health and Human Services/Centers for Disease Control and Prevention [U62P024421]
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention
- Global AIDS Program
Background. Although dihydroartemisinin-piperaquine (DP) is used primarily in children, pharmacokinetic/pharmacodynamic (PK/PD) data on DP use in young children are lacking. Methods. We conducted a prospective PK/PD study of piperaquine in 107 young children in Uganda. Samples were collected up to 28 days after 218 episodes of malaria treatment, which occurred during follow-up periods of up to 5 months. Malaria follow-up was conducted actively to day 28 and passively to day 63. Results. The median capillary piperaquine concentration on day 7 after treatment was 41.9 ng/mL. Low piperaquine concentrations were associated with an increased risk of recurrent malaria for up to 42 days, primarily in those receiving trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis. In children not receiving TMP-SMX, low piperaquine concentrations were only modestly associated with an increased risk of recurrent malaria. However, for children receiving TMP-SMX, associations were strong and evident for all sampling days, with PQ concentrations of < 27.3 ng/mL on day 7 associated with a greatly increased risk of recurrent malaria. Notably, of 132 cases of recurrent malaria, 119 had detectable piperaquine concentrations at the time of presentation with recurrent malaria. Conclusions. These piperaquine PK/PD data represent the first in children < 2 years of age. Piperaquine exposure on day 7 correlated with an increased risk of recurrent malaria after DP treatment in children receiving TMP-SMX prophylaxis. Interestingly, despite strong associations, infants remained at risk for malaria, even if they had residual levels of piperaquine.
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