...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Proceedings of the National Academy of Sciences of the United States of America >Benefits of using multiple first-line therapies against malaria
【24h】

Benefits of using multiple first-line therapies against malaria

机译：使用多种针对疟疾的一线疗法的好处

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Despite the availability of many drugs and therapies to treat malaria, many countries' national policies recommend using a single first-line therapy for most clinical malaria cases. To assess whether this is the best strategy for the population as a whole, we designed an evolu-tionary-epidemiological modeling framework for malaria and compared the benefits of different treatment strategies in the context of resistance evolution. Our results show that the population-wide use of multiple first-line therapies (MFT) against malaria yields a better clinical outcome than using a single therapy or a cycling strategy where therapies are rotated, either on a fixed cycling schedule or when resistance levels or treatment failure become too high. MFT strategies also delay the emergence and slow the fixation of resistant strains (phenotypes), and they allow a larger fraction of the population to be treated without trading off future treatment of cases that may be untreatable because of high resistance levels. Earlier papers have noted that cycling strategies have the disadvantage of creating a less temporally variable environment than MFT strategies, making resistance evolution easier for the parasite. Here, we illustrate a second feature of parasite ecology that impairs the performance of cycling policies, namely, that cycling policies degrade the mean fitness of the parasite population more quickly than MFT policies, making it easier for new resistant types to invade and spread. The clinical benefits of using multiple first-line therapies against malaria suggest that MFT policies should play a key role in malaria elimination and control programs.
机译：尽管有许多治疗疟疾的药物和疗法可供使用，但是许多国家的国家政策建议对大多数临床疟疾病例使用单一的一线疗法。为了评估这是否是整体人群的最佳策略，我们设计了一种针对疟疾的进化流行病学建模框架，并在耐药性演变的背景下比较了不同治疗策略的益处。我们的结果表明，与使用单一疗法或轮换治疗方案（轮换使用固定周期的时间表或耐药水平或当耐药水平达到一定水平）相比，在人群中广泛使用多种抗疟疾的一线疗法（MFT）可产生更好的临床效果。治疗失败变得过高。 MFT策略还延迟了耐药菌株（表型）的出现并减慢了其固定速度，并且它们允许治疗更大比例的人群，而不必权衡因高耐药水平而无法治疗的未来治疗方案。较早的论文已经指出，与MFT策略相比，循环策略的缺点是创建时间变化较小的环境，从而使寄生虫更容易产生抗性。在这里，我们说明了寄生虫生态学的第二个特征，该特征会损害骑自行车政策的性能，即骑自行车政策比MFT政策更快地降低了寄生虫种群的平均适应度，从而使新的抗药性物种更容易入侵和传播。使用多种针对疟疾的一线疗法的临床益处表明，MFT政策应在消除疟疾和控制计划中发挥关键作用。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号