HIEU Ll/C VA HIEU QUATHUOC PHOI HOP DIHYDROARTEli/IISININ - PIPERAQUINE TRONG DIEU TRj SOT RET DO Plasmodium falciparum
CHl/A BIEN CHUfNG TAI XA HAM CAN, HUYEN HAM THUilN NAM, T I N H BINH THUAN
Huynh Hdng Quang', Bui Quang Phuc^.
Gi&i thieu: Lieu phap thuoe phoi hpfp co artemisinin ma ra co hgi ti8n &kn loai trir sot ret tai cac viing nhiet dai, trong do dihydroartemisinin - piperaquine (DHA - PPQ) la mpt trong 5 nhom thuoe phoi hop co goc artemisinin vcri uu diem dilu tri s6t ret hieu qua tren ngudi tai Viet Nam va tren khap the giaii'^i, nhung gan day to ra giam hieu lire tai mot s6 viing trong khu vue tieu viing Me Kongn^i, eo the din d^n nguy ea thdt bai tidm tang. Phuomg phdp: Thi6t kg theo thir nghiem lam sang khong ngau nhien, khong doi chung, theo doi 42 ngay tren cac benh nhan sot ret chua bien chung do P. falciparum, nham danh gia hi?u luc va hieu qua phoi hap dihy- droartemisinin (DHA) - piperaquin (PPQ). Kit qud: Nghien euu in vivo tren 48 benh nhan tudi tir 3 - 60, ty le chiia khoi la 100%, khong co thAt bai digu tri. Tren 73 ea s6t ret do P. falciaprum khong bien chung dup'c danh gia hieu qua tai phong kham ciing cho hieu qua cao tuyet d6i 100%
va thai gian lam sach ky sinh tning the vo tinh deu ngan, khong c6 ca ton tai ky sinh trimg ngay Dj. Ket luan: Lieu phap phoi hop DHA - PPQ ngan ngay, hieu luc cao trong dieu tri sot ret chiia bien chung do P. falciparum.
Tur khoa: Plasmodium falciparum, Dihydroartemisinin - piperaquin phosphate, hieu lire, hieu qua.
DAT VAN DE
Ky sinh trung Plasmodium falciparum da khang thuoe lan rpng nghiem ti-png tren the gidi va dac biet tai cac quoc gia khu vi/c tieu viing song Me Kong nhu" mpt thach thiJc Idn cho viec luia chpn thuoe sot ret. O Viet Nam, P.
fylciparum khang cao vdi hau het cac tiiuoc sot ret co dien va giam dap uhg vdi nhieu loai mdi hien diing. TCr nam 1990, thuoe artemisinin va dan chat artesunate dUdc tien hanh thir nghiem lam sang va chinh thiit du^ vao su" dung
' " I (('n SSl rei - Ky smh triing - Con iriing Quy Nhan. Binh Dinh, '-' Vien Sol ri-l - Kv smh Iriing - Con iriing Trung uang.
Ng4> DhfD b i i : 01/7/2015
\^a\ phHD bifn l o n g : 14/7/2015 Ngiy duyft d i n g : 31 '7/2015
S^aiA chiu t r i c h nhi^m ngi dung khoa hpc: Huynh Hong Quang. Vien Sol I'-i - Kv sinh trung- Con ining Qvy Nhan, Binh Djnh Pit II ihfxfi 0905103496: E-Mail. huynhquangimpe@\ ahoa i om
d Viet Nam gop phan y nghia trong viec ha thap sdt ret ac tinh va tir vong. Song, gan day, da cd nhOtig dau hieu dang lo ngai khi cac so lieu cdng bo khang artemisinin d Campuchia, Thai Lan, Viet Nam, Myanmar va Lio do P.
falciparuni^^l Vi khang co nguy cd lan rpng, nen yeu tau giam sat hieu li/c thudc tai cac tinh co sot ret lulj hanh vdi cac thudc sir dung dau tay la rat can thiet, nhat la cac thuoe phoi hdp cd artemisinins (ACTs) nhu" dihy- droartemisinin - piperaquin (DHA - PPQ) nham danh gia tinh nhay khang cua thuoe. Do vay, nghien cijtj nay ben hanh tai xa Ham Can (viing sdt ret lu\j hanh nang ciia ti'nh Binh Thuan) nham muc tieu danh gia hieu ii/c va hieu qua phac do DHA - PPQ trong dieu trj sot ret do P. falciparum chiia bien chiitig tai cpng dong.
TRUYtWNHieMVllTNAM* SO 3 ( 1 1 ) - 2 0 1 5 - 1 9
D O I Tl/ONG VA PHU'ONG PHAP
Dja di^m, thdi gian nghien cu\i: Danh gia hieu li/c: Xa Ham Can co sot ret lu\j hanh, thupe huyen Ham Thuan Nam, tinh Binh Thuan; Danh gia hieu qua: Widng kham da khoa Ham Can; Thdi gian: tii tiiang 7/2012 - 4/2013.
Doi tifdng nghien cutti
Danh gia hieu fUc: Benh nhan sot ret do P. falci- parum chu^ bien chvtng
Tieu chuan chon benh: Tuoi tii 3 - 60 tuoi; Nhiem ddn thuan ky sinh trung sot ret R falciparum; Mat dp the vo tinh ciia KSTSR P. fyiciparum trong mau > 1.000 - s 100.000/pl mau; C6 sot: nhiet dp nach > 37,5*'C hoac tien sir CO sot trong vong 48 gid tn/dc nghien ciftj; Benh nhan co kha nSng nuot va uong thuoe; Chiia diing bat ky loai thuoe sdt ret nao tnrdc do; Benh nhan hoac gia dinh dong y hdp tac nghien ciiU.
T7eu chuin loai tru": Nhd hdn 3 tuoi va idn hdn 60 tuoi;
Mat dp KSTSR > lOO.OOO/pl mau (vi nguy cd sdt ret ac tinh); Phu nU cd thai (test thir dudng tinh) hoac dang cho con bu; Benh nhan sot ret R falciparum co bien chiJng, doi hdi phai nhap vien, hoac non tram trpng, khong hap thu du'dc thudc; hoac hien dang mac benh nhiem trung khac; Nhiem sot ret phoi hdp P. falciparum vdi loai khac.
ThuSc sot ret su" dyng trong nghien cih/; Thudc phdi hpp 40mg dihydroartemisinin - 320mg piperaquin phos- phat, biet du'dc Arterakine® vien nen, trong thanh phan CO tiiem it ta du'dc vira dii 1 vien. So 16 tiiuoc 11007, NSX:
22.09.2011, HSD: 1.09.2015 do Cong ty CPDP TW 1 san xuat.
Phu'dng phap: L i mpt thir nghiem lam sang khdng ngau nhien, khong doi chiing.
Cd mau toi thieu
• Trong danh gia hieu lyc in vivo, neu chpn ty le Oiat b^i dieu tri ciia tiiuoc DHA - PPQ la 10%, vdi khoang tin cay 95%, dp chinh xac (d) 10%. Khi do cd mau toi thieu can nghien culi danh gia hieu [u'e la 35"". Tranh si/ mat mau do tiieo doi dai ngay, nen cpng tiiem 20%. Cudi ciing c3 mau can la 35 + (20% x 35) ^ 42 ca.
- Trong danh gia hieu qua DHA - PPQ tai phong kham Ham Can, c9 m l u se lay toan bp so ca SR do R falciparum den dieu tri trong thdi gian trien khai nghien a i l i in vivo.
Phic do thudc su" dung trong nghien dhi: Vien nen dihydroartemisinin - piperaquine (biet du'dc Arterakine),
lieu trinh 3 ngay, uong thuoe sau biiS an khoang 30 phut theo phac do ciia Bp Y te (2009)fi'.
Ky thuat nghien cihi Banh gia thong so lam sang
Oanh gia lam sang se thiic hien tren tat ca ddi tudng va thut hien kham tiii/c tiie vao thdi diem bat dau nghien ciftj (Do) cung nhu" vao cac ngay D^ ^ 3 j_ „_ ^j ^g 35 va D42. Tien hanh ghi nhan benh sii", thdng tin hjoi, gidi tinh, dja chi, can nang, do than nhiet day dii va ghi lai chi tiet.
Xet nghiem lam mau va xac djnh mat dp Icy sinh trung sot ret (MBKSTSR)
- Xet nghiem lam mau gipt day va mdng, dem KSTSR de sang Ipc vao ngay DQ va xac djnh tieu chuan chpn benh hoac tieu chuan loai trir. Lam gipt day ciJng se kiem tra vao cac ngay tiep theo tu' D^ 2,3,7,14,21,2a, 35 ^a D^j.
- 3 lam mau (2 lam gipt day va 1 lam gipt mdng) cho moi benh nhan, trong do 1 lam se nhupm nhanh (giem sa 10% trong 10 -15 phut) doi vdi sang loc ban dau, trong khi cac lam khac chiing ta van nhupm chuan binh thu'dng.
Vi khi dii tieu chuan chon vao nghien CUIJ, chung ta se nhupm lam thu' 2 can than hdn (nong dp giem sa 2,5 - 3,0% trong 45 - 60 phut).
- MDKSTSR dii tieu chuan dua vao > 1.000 - <
100.000 the vo tinh/pl va mat dp ky sinh triing sot ret du'dc tinh nhu" sau:
So lu'dng KSTSR dem du'dc x 8.000 MDKSTSR/pl= — ; ^ TT^^
So lu'dng bach cau dem du'dc.
- 2 xet nghiem vien KHV chuyen ve KSTSR se soi dpc lap tat ca iam mau va dem MOKSTSR bang so ti-ung binh cua hai ngu'di. Lam mau co ket qua khong tu'dng iing (khac nhau giu^a hai XNV ve chimg loai KSTSR hoac khac nhau ve MDKSTSR hdn 50%) se diTdc kiem ti^ lai lan tiiir 3 bdi mpt XNV doc lap va MOKSTSR se du'dc b'nh so tiling binh cua 2 ngu'di cd gia tri gan tu'dng du'dng.
- Quy trinh ky thuat tren ap dung cho ca danh gia hieu qua va hieu li/c thuoe DHA - PPQ.
Cac chi tieu danh gia
- Danh gia hieu lu'c: That bai dieu ti-j sdm (ETF), that bai lam sang mupn (LCF), that bai ky sinh triing mupn (LPF), dap ling lam sang va ky sinh tiling day dii (ACPR) theo tieu chuan quy djnh ciia To chii'c Y te The gidi (2009). Thcfi gian lam sach ky sinh tiling ti-ung binh (PCT)
9 0 . TDiiv£»iiuu£utn£-rMABa.b
va tiidi gian cat sot bung binh (FCT).
- Oanh gia hieu qua dieu trj: Ty le sach KSTSR the vo tinh trong va sau khi ket tiiuc lieu trinh thuoe.
Phan tich va xu" ly so lieu: So lieu phan ti'ch va xu* ly theo bang In vivo cua TCYTTG, phien ban 7.1 (2009).
Khia canh dao du'c trong nghien cihi
Thu'c hien day dii ve cac bu'dc: su' chap thuan ciia Hpi diSng dao du'c y sinh, thu'c hanh lam sang tot (GCPs), cam ket tham gia nghien ciiu thong qua ky ban chap thuan, bao mat thong tin va sd lieu nghien cuU va dich vu cham soc y te.
KET QUA
Hieu lii'c phac do DHA - PPQ trong dieu tri sot ret do P. falciparum
Bac diem cua nhom benh nhan du tieu chuan nghien culf
Bang 1 . Mot so dac diem vie dan so hoc tren nhom benh nhan nghien cu'u hieu lu'c (n = 4 7 ]
TT
1
2
3
Dac dilm nhom benh nhan Gidi tinh
-Nam -N&
Nhdm tuoi
< 5
> 5 (Jen = 15
> IS Can nang trung binh (min-max) kg
Thdi diem bat i^u (ng^y Dg) So lu'dng
32 15
2 12 33 43 (14 - 72}
T y l # 68,09%
31.91%
4,26%
25,53%
70,21%
Benh nhan Nam chiem ty le cao hdn Nii (68,09% va 31,91%), nhdm benh nhan tuoi tren 15 chiem u\j the vdi 33 (70,21%), can nang trung binh la 43 kg.
Bang 2. Dac diem lam sang va ky sinh trung P. falciparum tren benh nhan nghien cihi hieu lu'c
{n = 4 7 ) TT
1
2
S^c di^m nhom benh nhan Than nhi^t ("C)
• So benh nhan co sot > 37,5°C.
- So ca khong c6 sot tai thcli diem DQ.
- Nhiet d? trung binh benh nhan - So ng^y sot trung binh t r u & D„
(ngiy).
M f d i , huy£t ap va nhjp thd TB - H ^ {lan/ phut).
- Huyet ap{mmHg}.
- Nhip ttKl ((in/phut).
Thdt diem bSt dau (ngay Dg)
30 (63,83%) 17 (36,17%) 38,1°C
2,1
68 105/60
32
TT
3
4
Bac diem nhom benh nhan Lich ldn
- Benh nhan co lach ldn.
- Benh nhan khong co lach idn.
Hat do KSTSR P. liilcipanim - MDKSr trung binh the vo tinh/jiL (tmng binh nhan, mm - max).
- So benh nhan c6 giao bao ngay DQ
Thcfi diSn bat ^ u (ngay Dg)
7 (14,8m) 40 (85,11%)
33.217(14.212-98.794)
7 (14,58%)
Ve mat lam sang, phan ldn benh nhan co sot tai thdi diem bat dau dua vao nghien ciili, tru'dc khi uong thuoe thir nghiem (63,83%) va 36,17% sd ca khong cd sot tai Oicfi diem tham kham. Cac thong so chiTc nang song khac binh thu'dng. So BNSR co lach ldn (dp I va I I ) chiem 14,89% va mat dp KSTSR trung binh the vd tinh 3 3 . 2 1 7 / M L mau.
Hieu lu'c phac do DHA - PPQ trong diieu trj benh nhan sot ret do P. falciparum
Bang 3. Phan loai hieu lu'c phac do DHA-PPQ lieu trinh 3 ngay
Chi so danh gia ETF, LCF, LPF ACPR
FCT (median, mm - max) (gicl) PCT (median, min - max) (gicS) TSng so phan tich MSt theo doi sau thcfi diem D14
So lu'dng ( % } 0 4 1 (lOOVo) 32(12-48) 36(12-60)
42 6
Tong so 47 ca R falciparum d\ia vao dieu trj bang DHA - PPQ cho thay khong cd that bai dieu tri, ty le dap iilig lam sang va KST day dii (ACPR) la 100%. Tat ca ca mat tiieo doi ia 6 tru'dng hdp va chi sau ngay D14.
Thdi gian cat sot trung binh la 32 gid; hieu lu'c lam sach ky sinh triing trung binh 36 gid.
Bang 4. Hieu qua dieu tri sot ret do P. falciparum cixa phac do DHA - PPQ (n = 73)
Ndi dung danh gia Gidi tinh
-Nam -ND' TUOI trung binh (min - max).
Mat do KSTSR ngay D^ (trung binh nhan).
Sach KST the vo tinh sau 24 gid.
Sacti KST t h ^ vo tinh sau 36 gid.
Sach KST the vo tinh sau 48 gid.
Sdlir^ng(%)
53 (72,6%) 20 (27,4%) 27,5 (3 - 52) 38.417/iiL 31 (42,47%) 72 (98,63%) 73(100%)
TRUY^IUHlEMVItTNAMASO 3(11) - 2015 - 2 1
Vdi mat dp KST tiie vo tinh tmng binh 38.417/mL, ttieo doi tiieo khoang each moi 12 gid, cho tiiay chi sau 36 gid dieu tij phac do DHA - PPQ cd den 98,63% so ca sach KSTSR va den thdi diem 48 gid sach hoan toan KSTSR d cac ca benh (100%).
BAN LUAN
Dac diem chung cua nhom benh nhan thuf nghiem danh gia hieu lu'c (In vivo)
Trong so 47 benh nhan dii tieu chuan tiiam gia nghien cuti tiiif nghiem lam sang khong ngau nhien, khdng doi chiJtig vdi tiiuoc phoi hdp DHA - PPQ, Nam chiem t / le cao hdn Nff (68,09% va 31,91%), nhdm tudi tren 15 chiem uU the vdi 70,21%. Dieu nay la phii hdp ciJng nhu"
cac nghien culJ dieu tra djch te sot ret tru'dc do. Nam gidi tru'dng thanh la cac doi tu'dng thu'dng xuyen tiep can va thi/c hien cac nghe nghiep lien quan vdi viing luU hanh sdt ret, ngu'dc lai Nff gidi va tre em it hdn, neu co chi vao cac mua thu hoach tai nha ray.
Tat ca benh nhan khong nam trong dang suy dinh duSng, can nang trung binh dat trong gidi han cho phep.
Ve mat lam sang, phan ldn cd sdt tai thdi diem du^ vao nghien ciili (63,83%), so con lai cd than nhiet trong gidi han binh thu'dng (36,17%) co the do d§c tinh ciia benh sot ret cd cdn, benh nhan da qua cdn sdt hoac tinh trang mien dich ciia benh nhan do hp song trong viing sdt ret luti hanh mpt thdi gian dai, nhieu ca se khdng bieu hien sot dien hinh, cac thong so chirc nang song nhu" mach, huyet ap, nhjp thd trong gidi han cho phep. Sd ca lach ldn trong dp I va I I chiem ty le thap (14,89%) do phan ddng la dan tai cho, nha sat bia riTng, thu'dng xuyen bi sot ret, song trong viing sdt ret lull hanh nang nhu' the cpng vdi SI/chong cdn sot lien tue khien lach tang sinh, xd hoa lach la cd tiie. Mat do KSTSR tmng binh tiie vo tinh 33.217/nL mau cho phep danh gia phii hdp ve hieu lu'c phac do DHA -PPQ.
Hieu IVc phac do thudc DHA - PPQ
Thuoe DHA - PPQ tn lieu vdi lieu trinh 3 ngay, theo doi 42 ngay tren in vivo theo khuyen cao ciia TCYTTG do Uiuoc trong thanh phan cd piperaquin co thdi gian ban hiiy trung binh dai it nhat 22 ngay, song khi diing nhieu lieu cao lien bep tiii tiidi gian ban hiiy cd ttie keo dai. Tong so 47 ca fi falciparum xac dinh du'a vao dieu tri bang DHA - PPQ cho tiiay khong cd that bai dieu tri sdm (ETF), that bai lam sang muon (LCF), that bai ky sinh trung mupn
(LPF), dac biet ty le dap litig lam sang va KST day du (ACPR) la tuyet doi 100%. Ket qua nay tu'dng tiT nhu' mot so thii' nghiem gan day d Phude Chien, Ninh "niuan va xa Xy, Quang Tn'^^i^i'^f^ va cd cao hdn so vdi ket qua tai Ptiu Thien, Gia Lai va Cu-Jut, Dak NongPi'ts'-t^.
So vdi cac nghien CUIJ tren the gidi tiJ' da tiung tam, tat ca sd lieu tren cho thay hieu lu'c doi vcfi R falciparum ciia phac do thuoe phoi hdp DHA - PPQ cao da du'dc ghi nhan trong Y van 5 nam trd lai day vcfi cS mau Idn, nghien cuti tir da trung tam tiJ- 94 - 100%[^]!'"]'i"J tai cac ffiem tiieo doi lien tue Trung Qudc, Campuchia, Myanmar, lio.
Thai Lan va Viet Nam.
Mpt trong nhuTig UIJ diem ciia phoi hdp tiiudc DHA • PPQ la thdi gian cat sdt trung binh (FCT) va tiidi gian lam sach KSTSR trung binh (PCT) rat ngan, tu'dng tiT nhy cac phdi hdp ACTs khac dang du'dc TCYTTG khuyen cao diing hien nay. Cu the FCT trong thir nghiem nay chi la 32 gic(
va PCT chi trong 36 gid. Hieu lu'c nay cdn the hien qua tdc dp lam sach KSTSR sau moi 12 hay 24 gid tij' Dl den D2.
SU lam sach KSTSR nhanh, dac biet the vo tinh se iian che SLT chuyen doi tir sdt ret thu'dng sang sot ret ac ti'nh.
Hieu qua DHA - PPQ trong dfeu trj sot ret do P. fal- ciparum chu'a bien chuTng tai phong kham
Vdi tong sd 73 ca den kham va nhap vien dieu tri tai phdng kham da khoa Ham C3n, trong do Nam gidi cung chiem \Su the (72,6%), tuoi trung binh benh nhan la 27,5. Vdi mat dp KST the vo tinh trung binh 38.417/fiL, phan tich ve mat lam sach ky sinh triing the vd tinh cho thay dien tien lam sach sau moi 12 gid thi chi sau 36 gicJ dieu tn phac do DHA - PPQ theo dung lieu trinh phac do Bp Y te, cd den 98,63% sd ca sach KSTSR va chi con lai 1 ca sau do den gid thir 48 da sach hoan toan tren lam mau benh nhan. Khdng con ca nao tdn tai KST sau 72 gid dieu t n .
KET LUAN
- Ty le dap iiTig lam sang va KST day dii cua tiiuoc phoi hdp DHA - PPQ la 100%, khong cd tru'dng hdp D3(+) va khong co ca that bai.
- Hieu qua phac do DHA - PPQ trong dieu tn benh nhan SR do P. falciparum tai phdng kham da khoa Ham Can cung cho ty le chu^ khdi 100% va sach KSTSR ttievo tinh hoan toan chi sau 48 gid.
2 2 -TRUYfeNNHliMVl|TNAM*s63
TAI U E U THAM KHAO
1. Bp Y te (2009), Hu'dng dan chan doan va dieu bi benh sot ret. Quyet dinh so 4605/QD-BYT, ngay 24 ttiang 11 nam 2009.
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3. Huynh Hong Quang, Nguyen Van ChUdng (2013).
Giam tinh nhay thuoe phdi hdp dihydroartemisinin-piper- aquine do Plasmodium falciparum: Cap nhat hien tu'dng khang thuoe artemisinins dau tien tai mpt viing sot ret lull hanh khong cd giao luU bien gidi Campuchia. Tap chi Y hoc thi/c hanh, Hpi nghj khoa hpc sang tao thay thudc tre lan thir I I , ISSN 1859 - 1663, sd 84 - 2013, trang 233 - 238.
4. Ta Thi TTnh, Nguyen Van Hu'dng, Biii Quang Phiic, Ngd Viet Thanh, Huynh Hong Quang, Du'dng Cong Thinh, Nguyen Manh Hiing (2011), "Hieu lu'c dieu tri mot sd thudc sot ret doi vdi Plasmodium falciparum giai doan 2005-2010", Cong tnnh NCKH. Bao cao Hoi nghi KST toan quoc lan th&SS, tip 1 - Benh sot ret, NXB Y hpc. Ha Npi, 2011, trang 9 5 - 1 0 3 .
5. Trieu Nguyen Trung, Huynh Hong Quang, Li Guo- qlao va cs, (2008). Oanh gia hieu li/c cac thudc ACTs trong dieu tri sot ret chuS bien chutig do R falciparum tai cac vung sdt ret luti hanh, mien Tmng - Tay Nguyen, Viet Nam (2004-2008). Tap chi Y hgc thanh pho Ho Chi Minh, Vol.
12 - phu ban sd 4: 28 - 34.
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tidmg - resistant Plasmodium faldparum Malaria in Preg- nancy: A Preliminary Report. Plos. Medicine 2011.
7. Bui Quang Phuc, Huynh Hong Quang, Tran Thanh Duong et al, (2013). Efficacy and safety of oral artesunate and dihydroartemisinin - piperaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Binh Thuan, Ninh Thuan, Daklak and Gia Lai provinces, Viet- nam 2011 - 2012. Journal for malaria and parasitic dis- ease contml, vol. 5 - 2013, ISSN 0868 - 3735, pp.84 - 89.
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Song (2013). Efficacy of artemisinin-based combination therapies in the treatment for uncomlicated falciaprum malaria - Central Vietnam, 2007 - 2011. The 7^ TEPHINET Biregional scientific conference, advanced public health for country development, Danang, Vietnam 12 - 1 4 Nov.
2013 p. 79.
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12. WHO (2013), Emergency response bD artemisinin resistance in the greater Mekong subregion. Regional framew/ork for action 2013 - 2015.
TRUYEN NHlilUI VIET N A M * SO 3(11) - 2015 - 2 3
EFFICACY AND EFFECTIVENESS OF DIHYDROARTEMISININ PLUS PIPERAQUINE COMBINATION THERAPY I N THE TREATMENT
FOR UNCOMPLICATED FALCIPARUM M A U R I A
AT HAM CAN COMMUNE, HAM THUAN NAM DISTRICT, BINH THUAN PROVINCE
Summary
Backgrounds: Artemisinin combinabon therapy (ACT) paves the way for new opportunibes to eliminate malaria in the tropics. The dihydroartemisinin-piperaquine (DHA - PPQ) is one of five promising new artemisinin combina- tion with highlights of effective in human in Vietnam and over tile world (WHO, 2013), but reduced efficacy in sev- eral senbnel sites in sub Mekong region led to potential failure risk. P4ethods: The study was designed as a non randomized controlled clinical trial 42-day follow up in un- complicated falciparum malaria, aim to assess of Dihy- droartemisinin (DHA) plus piperaquin (PPQ) efficacy.
Results: The study was conducted involving 48 patients aged 3 - 60 years, the cure rate DHA - PPQ combination was 100% without treatment feilure. And on total of 73 felciparum case had treated by 3 day course at Ham Can clinic, effiecttveness was also absolute 100%, mean para- site clearance time was short, no case with D3 positive, Conclusions: These data suggest that dihydroartemisinin plus piperaquin, short-course regimes for 3 days were highly efficacious combination treatments for uncompli- cated falciparum malaria.
Key virords; Plasmodium felcipamm, dihydroartemisinin - piperaquin phosphate, efficacy, effectiveness.
24-TRUY^NIMHieMVirrNAM*s63(11)-2015
