Yadav Rajpal S, Ghosh S K
Malaria Research Centre, Field Station, Rourkela, Orissa, India.
J Parasitol. 2002 Oct;88(5):1042-4. doi: 10.1645/0022-3395(2002)088[1042:RCEOFD]2.0.CO;2.
For over 4 decades the antimalarial program in India has been prescribing a 5-day primaquine regimen as an antirelapse therapy to treat Plasmodium vivax malaria. In view of conflicting reports on the effectiveness of this regimen in the Indian subcontinent, and the varying prevalence of P. vivax in various ecosystems in India, the antirelapse efficacy of this regimen was evaluated in Orissa, a malaria endemic state in eastern India where P. falciparum predominates. In 723 cases of P. vivax infection treated with chloroquine alone and followed up weekly for 1 yr, the prevalence of recurrence of parasitaemia with fever was 8.6%. Among another 759 P. vivax cases treated with chloroquine and a 5-day regimen of primaquine at 15 mg/day (adult dose), the recurrence of infection was 6.5%. The difference in recurrence was not significant (P = 0.53). It is important to note that in a great majority of cases of P. vivax in this area, infection did not recur even without treatment with primaquine. This finding, that the use of the 5-day primaquine regimen with chloroquine had no significant advantage over the use of chloroquine alone, undermines the rationale of using primaquine as an antirelapse drug in forested areas with a high prevalence of P. falciparum.
四十多年来，印度的抗疟项目一直采用为期5天的伯氨喹治疗方案作为抗复发疗法，用于治疗间日疟原虫疟疾。鉴于关于该方案在印度次大陆有效性的报道相互矛盾，且印度不同生态系统中间日疟原虫的流行率各异，于是在印度东部疟疾流行的奥里萨邦（该地区以恶性疟原虫为主）对该方案的抗复发疗效进行了评估。在723例仅接受氯喹治疗且每周随访1年的间日疟原虫感染病例中，出现发热伴寄生虫血症复发的比例为8.6%。在另外759例接受氯喹和每日15毫克（成人剂量）为期5天的伯氨喹治疗方案的间日疟原虫病例中，感染复发率为6.5%。复发率的差异不显著（P = 0.53）。需要注意的是，在该地区绝大多数间日疟原虫病例中，即便不使用伯氨喹治疗感染也未复发。这一发现，即氯喹联合为期5天的伯氨喹治疗方案相较于单独使用氯喹并无显著优势，削弱了在恶性疟原虫高流行的林区将伯氨喹用作抗复发药物的理论依据。
