Kublin James G, Cortese Joseph F, Njunju Eric Mbindo, Mukadam Rabia A G, Wirima Jack J, Kazembe Peter N, Djimdé Abdoulaye A, Kouriba Bourema, Taylor Terrie E, Plowe Christopher V
Malaria Section, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, USA.
J Infect Dis. 2003 Jun 15;187(12):1870-5. doi: 10.1086/375419. Epub 2003 May 21.
In 1993, Malawi became the first African country to replace chloroquine with sulfadoxine-pyrimethamine nationwide in response to high rates of chloroquine-resistant falciparum malaria. To determine whether withdrawal of chloroquine can lead to the reemergence of chloroquine sensitivity, the prevalence of the pfcrt 76T molecular marker for chloroquine-resistant Plasmodium falciparum malaria was retrospectively measured in Blantyre, Malawi. The prevalence of the chloroquine-resistant pfcrt genotype decreased from 85% in 1992 to 13% in 2000. In 2001, chloroquine cleared 100% of 63 asymptomatic P. falciparum infections, no isolates were resistant to chloroquine in vitro, and no infections with the chloroquine-resistant pfcrt genotype were detected. A concerted national effort to withdraw chloroquine from use has been followed by a return of chloroquine-sensitive falciparum malaria in Malawi. The reintroduction of chloroquine, ideally in combination with another antimalarial drug, should be considered in areas where chloroquine resistance has declined and safe and affordable alternatives remain unavailable.
1993年，马拉维成为首个在全国范围内用磺胺多辛-乙胺嘧啶取代氯喹的非洲国家，以应对恶性疟原虫对氯喹的高耐药率。为了确定停用氯喹是否会导致氯喹敏感性的重新出现，在马拉维布兰太尔对恶性疟原虫氯喹耐药的pfcrt 76T分子标记物的流行情况进行了回顾性测量。氯喹耐药pfcrt基因型的流行率从1992年的85%降至2000年的13%。2001年，氯喹清除了63例无症状恶性疟原虫感染中的100%，体外无分离株对氯喹耐药，也未检测到氯喹耐药pfcrt基因型的感染。马拉维全国齐心协力停用氯喹后，氯喹敏感的恶性疟又重新出现。在氯喹耐药性已下降且仍无安全且负担得起的替代药物的地区，应考虑重新引入氯喹，理想情况下与另一种抗疟药物联合使用。
