I-BugBitten Albendazole ye-Lymphatic Filariasis… Ukubetha ngokuthe ngqo okanye u-Misfire?

Kwiminyaka engamashumi amabini, i-albendazole inikezelwe kwiprogram enkulu yonyango lwe-lymphatic filariasis. Uphononongo lwamva nje lwe-Cochrane luhlolisise ukusebenza kwe-albendazole kunyango lwe-lymphatic filariasis.
I-Lymphatic filariasis sisifo esixhaphakileyo kwiindawo ezishushu kunye neendawo ezitshisayo, ezisasazwa ziingcongconi kwaye zibangelwa sisifo se-parasitic filariasis. Emva kosulelo, imibungu ikhula ibe ngabantu abadala kwaye iqabane yenze i-microfilariae (MF). Ingcongconi ke ithatha iMF ngelixa isondla igazi, kwaye usulelo lunokudluliselwa komnye umntu.
Usulelo lunokufunyaniswa ngovavanyo lwe-MF ejikelezayo (microfilamentemia) okanye ii-antigens zeparasite (i-antigenemia) okanye ngokufumanisa iintshulube zabantu abadala ezisebenzayo nge-ultrasonography.
UMbutho wezeMpilo weHlabathi (i-WHO) ucebisa ukuba kunyangwe abantu abaninzi ngonyaka ubuncinci iminyaka emihlanu. Isiseko sonyango yindibaniselwano yamachiza amabini: i-albendazole kunye ne-microfilaricidal (i-antifilariasis) i-diethylcarmazine yeziyobisi (DEC) okanye ivermectin.
I-Albendazole yodwa icetyiswa ukuba isetyenziswe kwi-semi-annual kwiindawo apho isifo se-Roa sidibene, apho i-DEC okanye i-ivermectin akufanele isetyenziswe ngenxa yengozi yemiphumo emibi.
Zombini i-ivermectin kunye ne-DEC zacoca ngokukhawuleza usulelo lwe-MF kwaye zacinezela ukuphindwa kwayo. Nangona kunjalo, imveliso yeMF iya kuqalisa kwakhona ngenxa yokuvezwa okulinganiselweyo kubantu abadala. I-Albendazole yathathelwa ingqalelo kunyango lwe-lymphatic filariasis emva kokuba uphononongo lubonise ukuba iidosi eziphezulu ezinikwe kwiiveki ezininzi zikhokelele kwiziphumo ebezingalindelekanga ezimandundu ezibonisa ukufa kweentshulube zabantu abadala.
Uthethwano olungekho sikweni lwe-WHO lubonise ukuba i-albendazole inomsebenzi wokubulala okanye wokubulala iintsholongwane kwiintshulube zabantu abadala. Ngo-2000, i-GlaxoSmithKline yaqalisa ukunikela nge-albendazole kwiiprojekthi zokunyanga i-lymphatic filariasis.
Izilingo zeklinikhi ezingahleliwe (RCTs) ziye zavavanya ukusebenza kunye nokhuseleko lwe-albendazole yedwa okanye ngokudibanisa ne-ivermectin okanye i-DEC. Emva koko, kukho uphononongo oluninzi olucwangcisiweyo lwezilingo ezilawulwa ngokungahleliwe kunye neenkcukacha zokujonga, kodwa akucaci ukuba i-albendazole inenzuzo nayiphi na i-lymphatic filariasis.
Ngenxa yoko, ukuhlaziywa kwe-Cochrane epapashwe kwi-2005 ihlaziywe ukuvavanya impembelelo ye-albendazole kwizigulane kunye noluntu olune-lymphatic filariasis.
Uphononongo lweCochrane luphononongo olucwangcisiweyo olujolise ekuchongeni, ukuvavanya, kunye nokushwankathela bonke ubungqina obunobungqina obuhlangabezana neenqobo ezimiselweyo zokuphendula umbuzo wophando. Uphononongo lweCochrane luyahlaziywa njengoko idatha entsha ifumaneka.
Indlela ye-Cochrane inciphisa ukuthambekela kwindlela yokuphonononga. Oku kubandakanya ukusebenzisa izixhobo zokuvavanya umngcipheko wokucalula kwiimvavanyo zomntu ngamnye kunye nokuvavanya ukuqinisekiswa (okanye umgangatho) wobungqina kwisiphumo ngasinye.
Inkcazo yeCochrane ehlaziyiweyo "i-Albendazole yodwa okanye idityaniswe ne-microfilaricidal agents kwi-lymphatic filariasis" yapapashwa ngoJanuwari ka-2019 liQela le-Cochrane I-Infectious Diseases Group kunye ne-COUNTDOWN Consortium.
Iziphumo zomdla ziquka ukosuleleka kweMF (ukuxhaphaka kunye noxinaniso), iziphawuli zosulelo lweentshulube zabantu abadala (i-antigenemia exhaphakileyo kunye nokuxinana, kunye nokubonwa kwe-ultrasound yeentshulube zabantu abadala), kunye nemilinganiselo yeziganeko ezimbi.
Ababhali bazame ukusebenzisa uphendlo lwe-elektroniki ukufumana zonke iimvavanyo ezifanelekileyo ukuya kuthi ga kuJanuwari ka-2018, kungakhathaliseki ulwimi okanye imeko yokupapashwa. Ababhali ababini bavavanya ngokuzimeleyo izifundo zokubandakanywa, ukuvavanywa komngcipheko wokungakhethi, kunye nedatha yovavanyo olukhutshwe.
Uphononongo lubandakanya izilingo ze-13 kunye nenani labathathi-nxaxheba be-8713. Uhlalutyo lwe-meta lokuxhaphaka kwee-parasites kunye nemiphumo emibi yenzelwe ukulinganisa iziphumo zonyango. Lungisa iitheyibhile ukuhlalutya iziphumo zoxinaniso lweparasite, njengoko ingxelo engekho mgangathweni ithetha ukuba idatha ayinakudityaniswa.
Ababhali bafumanisa ukuba i-albendazole yodwa okanye idibene ne-microfilaricides ayinayo impembelelo kwi-MF phakathi kweeveki ezimbini kunye neenyanga ze-12 emva kokunyanga (ubungqina obuphezulu).
Abazange bazi ukuba kukho impembelelo kwi-mf density kwiinyanga ze-1-6 (ubungqina obuphantsi kakhulu bekhwalithi) okanye kwiinyanga ze-12 (ubungqina obuphantsi kakhulu).
I-Albendazole yodwa okanye idibene ne-microfilaricides ayinayo impembelelo ekuxhasweni kwe-antigenemia kwiinyanga ze-6-12 (ubungqina obuphezulu).
Ababhali babengazi ukuba kukho impembelelo kwi-antigen density phakathi kwe-6 kunye ne-12 yeenyanga ubudala (ubungqina obuphantsi kakhulu). I-Albendazole yongezwa kwi-microfilaricides mhlawumbi yayingenalo impembelelo ekuxhasweni kweembungu zabantu abadala ezifunyenwe yi-ultrasound kwiinyanga ze-12 (ubungqina obuncinane).
Xa isetyenziswe yodwa okanye idibene, i-albendazole yayinempembelelo encinci kwinani labantu ababika iziganeko ezimbi (ubungqina obuphezulu).
Uphononongo lufumene ubungqina obaneleyo bokuthi i-albendazole, yodwa okanye idibene ne-microfilaricides, ayinayo impembelelo encinci okanye ayinayo impembelelo ekupheliseni ngokupheleleyo i-microfilariae okanye i-helminths yabantu abadala kwiinyanga ezili-12 zonyango.
Ngenxa yokuba eli chiza liyinxalenye yomgaqo-nkqubo oqhelekileyo, kwaye uMbutho wezeMpilo weHlabathi ngoku ucebisa irejimeni yeziyobisi ezintathu, akunakwenzeka ukuba abaphandi baya kuqhubeka nokuvavanya i-albendazole ngokudibanisa ne-DEC okanye ivermectin.
Nangona kunjalo, kwiindawo eziqhelekileyo ze-Roa, kuphela i-albendazole ecetyiswayo. Ke ngoko, ukuqonda ukuba ingaba iyeza liyasebenza na kolu luntu kuhlala kungumba ophambili wophando.
Izinambuzane ezinkulu ze-filariatic ezineeshedyuli zokusetyenziswa kwexesha elifutshane zinokuba nefuthe elikhulu kwiiprogram zokuphelisa i-filariasis. Elinye lala machiza likuphuhliso lwangaphambili kwaye lipapashwe kwibhlog yeBugBitten yakutshanje.
Ngokuqhubeka usebenzisa le ndawo, uyavumelana neMigqaliselo yethu yokuSetyenziswa, iziKhokelo zoLuntu, iNgxelo yaBucala kunye noMgaqo-nkqubo weCookie.


Ixesha lokuposa: Jun-26-2023