Anabwani G, Canfield C J, Hutchinson D B
Moi University, Faculty of Health Sciences, Eldoret, Kenya.
Pediatr Infect Dis J. 1999 May;18(5):456-61. doi: 10.1097/00006454-199905000-00011.
Malaria is a major cause of pediatric mortality in sub-Saharan Africa. Worldwide estimates of mortality among children with Plasmodium falciparum malaria range from 1 to 2 million deaths per year. Management of malaria is increasingly difficult because of the global spread of drug-resistant strains of P. falciparum. There is an urgent need for safe and effective new therapies to treat multidrug-resistant malaria.
This open label, randomized trial compared atovaquone and proguanil hydrochloride with halofantrine for treatment of acute, uncomplicated P. falciparum malaria in children age 3 to 12 years (84 patients per group). Study drug dosages were adjusted by weight (approximately 20 and 8 mg/kg daily for three doses for atovaquone and proguanil hydrochloride and 8 mg/kg every 6 h for three doses for halofantrine). Patients were monitored by serial clinical and laboratory assessments for 28 days after starting treatment.
Both regimens were effective (cure rate, 93.8% for atovaquone and proguanil hydrochloride and 90.4% for halofantrine) and produced prompt defervescence. Mean parasite clearance times were 50.2 h for halofantrine and 64.9 h for atovaquone and proguanil hydrochloride. More adverse experiences were reported in children treated with halofantrine (119) than with atovaquone and proguanil hydrochloride (73).
In Kenyan children the combination of atovaquone and proguanil hydrochloride has efficacy comparable with that of halofantrine for treatment of acute uncomplicated multidrug-resistant falciparum malaria and is associated with a lower rate of adverse events.
疟疾是撒哈拉以南非洲地区儿童死亡的主要原因。全球范围内，感染恶性疟原虫的儿童死亡率估计每年在100万至200万之间。由于恶性疟原虫耐药菌株在全球传播，疟疾的治疗愈发困难。迫切需要安全有效的新疗法来治疗多重耐药疟疾。
本开放标签随机试验比较了阿托伐醌和盐酸氯胍与卤泛群治疗3至12岁儿童急性非复杂性恶性疟原虫疟疾的疗效（每组84例患者）。研究药物剂量根据体重调整（阿托伐醌和盐酸氯胍每日约20毫克/千克，分3剂服用；卤泛群每6小时8毫克/千克，分3剂服用）。开始治疗后，通过连续的临床和实验室评估对患者进行28天监测。
两种治疗方案均有效（阿托伐醌和盐酸氯胍的治愈率为93.8%，卤泛群为90.4%），且能迅速退热。卤泛群的平均寄生虫清除时间为50.2小时，阿托伐醌和盐酸氯胍为64.9小时。报告显示，接受卤泛群治疗的儿童（119例）出现的不良事件比接受阿托伐醌和盐酸氯胍治疗的儿童（73例）更多。
在肯尼亚儿童中，阿托伐醌和盐酸氯胍联合用药治疗急性非复杂性多重耐药恶性疟原虫疟疾的疗效与卤泛群相当，且不良事件发生率较低。
