White Nicholas J
Faculty of Tropical Medicine, Mahidol University, 10400, Bangkok, Thailand.
Trends Parasitol. 2002 Oct;18(10):458-64. doi: 10.1016/s1471-4922(02)02373-5.
Antimalarial drug efficacy in uncomplicated malaria should be assessed parasitologically in large, community-based trials, enrolling the age groups most affected by clinical disease. For rapidly eliminated drugs, a 28-day follow-up is needed, but, for slowly eliminated drugs, up to nine weeks could be required to document all recrudescences, and, when possible, the drug levels should also be measured. The WHO 14-day assessments are neither sensitive nor specific. In tropical Plasmodium vivax and Plasmodium ovale infections treated with chloroquine, the first relapse is usually suppressed by residual drug levels. A relapse cannot be distinguished confidently from a recrudescence. Host immunity is a major contributor to the therapeutic response, and can make failing drugs appear effective.
在大规模的社区试验中，应通过寄生虫学方法评估抗疟药物对非复杂性疟疾的疗效，试验应纳入受临床疾病影响最大的年龄组。对于快速消除的药物，需要进行28天的随访，但对于消除缓慢的药物，可能需要长达九周的时间来记录所有复发情况，并且在可能的情况下，还应测量药物水平。世卫组织的14天评估既不敏感也不特异。在用氯喹治疗的热带间日疟原虫和卵形疟原虫感染中，首次复发通常会被残留的药物水平抑制。复发无法与再燃可靠地区分开来。宿主免疫是治疗反应的主要因素，可能会使失效的药物看起来有效。
