Bourgeade A, Delmont J
Service des maladies infectieuses et tropicales, Hôpital Houphouët-Boigny, Marseille.
Bull Soc Pathol Exot. 1998;91(5 Pt 1-2):493-6.
French medical practitioners have at their disposal several antimalarial drugs for giving chemoprophylaxis to people travelling to a malaria endemic country or treating an imported malaria case in a patient. The choice depends on the contre-indications and indications of each drug, essentially subordinated to the presence and level of Plasmodium falciparum chemosensitivity in the visited area. For prevention, chloroquine alone can be taken in the areas where P. falciparum is absent or not chloroquine resistant; elsewhere, the choice between chloroquine/proguanil or mefloquine depends on knowing the prevalence and level of falciparum chloroquine resistance in these areas. For treatment, the only indications of chloroquine are imported malaria cases either due to P. vivax, P. ovale or P. malariae, or caused by P. falciparum contracted in one of the rare countries where the species is still sensitive to chloroquine. For uncomplicated falciparum malaria cases acquired in a chemoresistance area, mefloquine, halofantrine, sulfadoxine-pyrimethamine or oral quinine is selected, depending on the observed chemoprophylaxis, the contra-indications and the suspicion of chemoresistance type. Whatever the provenance area, P. falciparum in a patient with one or several serious symptoms or possibly profuse vomiting is treated by intravenous quinine, associated with tetracycline if the patient comes from an area known for a low quinine sensitivity of this species. The spectrum of falciparum malaria treatment has recently broadened to include new drugs such as artemisinin, artemether or atovaquone/proguanil, the latter being as yet unauthorized in France.
法国医生有多种抗疟药物可供使用，用于对前往疟疾流行国家的人员进行化学预防，或治疗患者的输入性疟疾病例。选择取决于每种药物的禁忌证和适应证，主要取决于所访问地区恶性疟原虫的化学敏感性情况及水平。对于预防，在没有恶性疟原虫或不存在氯喹耐药性的地区，可单独服用氯喹；在其他地区，氯喹/乙胺嘧啶或甲氟喹的选择取决于这些地区恶性疟原虫氯喹耐药性的流行情况和水平。对于治疗，氯喹的唯一适应证是由间日疟原虫、卵形疟原虫或三日疟原虫引起的输入性疟疾病例，或在该物种仍对氯喹敏感的少数国家之一感染的恶性疟原虫所致病例。对于在化学耐药地区获得的非复杂性恶性疟病例，根据观察到的化学预防情况、禁忌证和对耐药类型的怀疑，选择甲氟喹、卤泛群、磺胺多辛-乙胺嘧啶或口服奎宁。无论来源地区如何，对于有一个或多个严重症状或可能有大量呕吐的患者中的恶性疟原虫，采用静脉注射奎宁治疗，如果患者来自已知该物种对奎宁敏感性较低的地区，则联合使用四环素。恶性疟治疗的药物范围最近有所扩大，包括青蒿素、蒿甲醚或阿托伐醌/氯胍等新药，后者在法国尚未获得批准。
