Piperonil butoksid (PBO) u kombinaciji s piretroidima u mrežama tretiranim insekticidima za sprječavanje malarije u Africi.
The Cochrane database of systematic reviews
Sažetak istraživanja
Pozadina Piretroidne dugotrajne insekticidne mreže (LLIN) bile su važne u velikom smanjenju slučajeva malarije u Africi, ali otpornost na insekticide kod komaraca Anopheles prijeti njihovom utjecaju. Insekticidni sinergisti mogu pomoći u kontroli populacija otpornih na insekticide. Piperonil butoksid (PBO) je takav sinergist; ugrađen je u piretroid-LLIN kako bi se formirale piretroid-PBO mreže, koje trenutno proizvodi pet LLIN proizvođača i, prema preporuci Svjetske zdravstvene organizacije (WHO) 2017. godine, uključene su u distribucijske kampanje. Ovaj pregled ispituje epidemiološke i entomološke dokaze o njihovoj efikasnosti dodavanja PBO piretroidnim mrežama.
Ciljevi Uporediti efekte piretroid-PBO mreža koje su trenutno u komercijalnom razvoju ili na tržištu sa efektima njihovog ne-PBO ekvivalenta u odnosu na: 1. infekciju parazitima malarije (prevalencija ili incidencija); i 2. entomološki ishodi.
Metode pretraživanja Pretražili smo specijalizovani registar Cochrane grupe za zarazne bolesti (CIDG), CENTRAL, MEDLINE, Embase, Web of Science, CAB Abstracts i dva registra kliničkih ispitivanja (ClinicalTrials. gov i Međunarodna platforma za registar kliničkih ispitivanja SZO) do 25. septembra 2020. godine. Kontaktirali smo organizacije za neobjavljene podatke. Provjerili smo referentne liste ispitivanja identificiranih ovim metodama. Kriterijumi odabira Uključili smo eksperimentalna ispitivanja u kolibama, seoska ispitivanja i randomizirana kontrolirana ispitivanja (RCT) s komarcima iz kompleksa Anopheles gambiae ili grupe Anopheles funestus. Prikupljanje i analiza podataka Dva autora pregleda su procijenila svako ispitivanje u pogledu podobnosti, izvukli podatke i utvrdili rizik od pristrasnosti za uključena ispitivanja. Nesuglasice smo riješili kroz razgovor sa trećim autorom recenzije. Analizirali smo podatke koristeći Review Manager 5 i procijenili sigurnost dokaza koristeći GRADE pristup. Glavni rezultati Šesnaest studija je ispunilo kriterijume za uključivanje: 10 eksperimentalnih ispitivanja u kolibama, četiri seoska ispitivanja i dva klaster-RCT-a (cRCT). Tri suđenja čekaju klasifikaciju, a četiri su u toku. Dva cRCT-a su ispitivala efekte piretroid-PBO mreža na prevalenciju parazita kod ljudi koji žive u područjima sa visoko otpornim na piretroide (smrtnost komaraca od 90%), može postojati mala ili nikakva razlika u efektima neopranih piretroid-PBO mreža u poređenju sa neopranim mortalnim standardom-LLINto, RRINto2. 95% CI 0,64 do 2,26 2791 komarac, 2 poređenja; Ovo je slično za oprane mreže (RR 1.07, 95% CI 0.92 do 1.25; 2644 komaraca, 2 ispitivanja, 2 poređenja; dokazi niske sigurnosti). Ne znamo da li su neoprane piretroid-PBO mreže imale bilo kakav uticaj na uspjeh hranjenja krvlju osjetljivih komaraca (RR 0,52, 95% CI 0,12 do 2,22; 2791 komarac, 2 ispitivanja, 2 poređenja; vrlo mala sigurnost). Isto vrijedi i za oprane mreže (RR 1,25, 95% CI 0,82 do 1,91; 2644 komaraca, 2 ispitivanja, 2 poređenja; dokazi niske sigurnosti). U seoskim ispitivanjima koja su upoređivala piretroid-PBO mreže sa LLINs, nije bilo razlike u stopi sporozoita (4 ispitivanja, 5 poređenja) niti u paritetu komaraca (3 ispitivanja, 4 poređenja).
Zaključci autora U područjima visoke otpornosti na insekticide, piretroid-PBO mreže imaju veću entomološku i epidemiološku efikasnost u odnosu na standardne LLIN, uz trajno smanjenje prevalencije parazita, veću smrtnost komaraca i smanjenje stope hranjenja komaraca krvlju 21 do 25 mjeseci nakon intervencije. Ostaju pitanja o trajnosti PBO-a na mrežama, budući da uticaj piretroid-PBO mreža na smrtnost komaraca nije postojao više od 20 pranja u eksperimentalnim ispitivanjima koliba, a epidemiološki podaci o piretroid-PBO mrežama za puni predviđeni trogodišnji životni vijek mreža nisu dostupni. Malo je dokaza koji podržavaju veću entomološku efikasnost piretroid-PBO mreža u područjima gdje komarci pokazuju niže razine otpornosti na piretroide.
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Piperonyl butoxide (PBO) combined with pyrethroids in insecticide-treated nets to prevent malaria in Africa.
Background Pyrethroid long-lasting insecticidal nets (LLINs) have been important in the large reductions in malaria cases in Africa, but insecticide resistance in Anopheles mosquitoes threatens their impact. Insecticide synergists may help control insecticide-resistant populations. Piperonyl butoxide (PBO) is such a synergist; it has been incorporated into pyrethroid-LLINs to form pyrethroid-PBO nets, which are currently produced by five LLIN manufacturers and, following a recommendation from the World Health Organization (WHO) in 2017, are being included in distribution campaigns. This review examines epidemiological and entomological evidence on the addition of PBO to pyrethroid nets on their efficacy.
Objectives To compare effects of pyrethroid-PBO nets currently in commercial development or on the market with effects of their non-PBO equivalent in relation to: 1. malaria parasite infection (prevalence or incidence); and 2. entomological outcomes. Search methods We searched the Cochrane Infectious Diseases Group (CIDG) Specialized Register, CENTRAL, MEDLINE, Embase, Web of Science, CAB Abstracts, and two clinical trial registers (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) up to 25 September 2020. We contacted organizations for unpublished data. We checked the reference lists of trials identified by these methods. Selection criteria We included experimental hut trials, village trials, and randomized controlled trials (RCTs) with mosquitoes from the Anopheles gambiae complex or the Anopheles funestus group. Data collection and analysis Two review authors assessed each trial for eligibility, extracted data, and determined the risk of bias for included trials. We resolved disagreements through discussion with a third review author. We analysed data using Review Manager 5 and assessed the certainty of evidence using the GRADE approach. Main results Sixteen trials met the inclusion criteria: 10 experimental hut trials, four village trials, and two cluster-RCTs (cRCTs). Three trials are awaiting classification, and four trials are ongoing. Two cRCTs examined the effects of pyrethroid-PBO nets on parasite prevalence in people living in areas with highly pyrethroid-resistant mosquitoes ( 90% mosquito mortality), there may be little to no difference in the effects of unwashed pyrethroid-PBO nets compared to unwashed standard-LLINs on mosquito mortality (RR 1.20, 95% CI 0.64 to 2.26; 2791 mosquitoes, 2 trials, 2 comparisons; low-certainty evidence). This is similar for washed nets (RR 1.07, 95% CI 0.92 to 1.25; 2644 mosquitoes, 2 trials, 2 comparisons; low-certainty evidence). We do not know if unwashed pyrethroid-PBO nets had any effect on the blood-feeding success of susceptible mosquitoes (RR 0.52, 95% CI 0.12 to 2.22; 2791 mosquitoes, 2 trials, 2 comparisons; very low-certainty evidence). The same applies to washed nets (RR 1.25, 95% CI 0.82 to 1.91; 2644 mosquitoes, 2 trials, 2 comparisons; low-certainty evidence). In village trials comparing pyrethroid-PBO nets to LLINs, there was no difference in sporozoite rate (4 trials, 5 comparisons) nor in mosquito parity (3 trials, 4 comparisons). Authors' conclusions In areas of high insecticide resistance, pyrethroid-PBO nets have greater entomological and epidemiological efficacy compared to standard LLINs, with sustained reduction in parasite prevalence, higher mosquito mortality and reduction in mosquito blood feeding rates 21 to 25 months post intervention. Questions remain about the durability of PBO on nets, as the impact of pyrethroid-PBO nets on mosquito mortality was not sustained over 20 washes in experimental hut trials, and epidemiological data on pyrethroid-PBO nets for the full intended three-year life span of the nets is not available. Little evidence is available to support greater entomological efficacy of pyrethroid-PBO nets in areas where mosquitoes show lower levels of resistance to pyrethroids.
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- DOI
- 10.1002/14651858.cd012776.pub3
- PMID
- 34027998
- PMCID
- PMC8142305
- Provjereno
- 2026-07-26
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