Sutherland Colin J, Drakeley Christopher J, Obisike Uche, Coleman Rosalind, Jawara Musa, Targett Geoffrey A T, Milligan Paul, Pinder Margaret, Walraven Gijs
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Am J Trop Med Hyg. 2003 Jul;69(1):19-25.
In a randomized controlled trial, chloroquine monotherapy was compared with the combination of artesunate and chloroquine for treating uncomplicated Plasmodium falciparum malaria in 536 Gambian children. Chloroquine-treated children exhibited a 28-day clinical failure rate of 15% (95% confidence interval [CI] = 9.2-22%) compared with 11% (7.8-15%) among children receiving the combination (P = 0.08, by Wilcoxon test). Seventy-three percent of chloroquine-treated children exhibited parasitemia during follow-up compared with 49% of children receiving the combination (relative risk = 1.5, 95% CI = 1.3-1.7; chi2 = 21.18, P < 0.001). A significant reduction in clinical and parasitologic treatment failure in the combination group occurred in the first two weeks following treatment, but this was eroded over weeks three and four of follow-up. The impact of combination therapy on the transmission of chloroquine-resistant parasites is discussed. Chloroquine plus artesunate is not sufficiently efficacious to justify its introduction as a replacement for chloroquine monotherapy in The Gambia.
在一项随机对照试验中，对536名冈比亚儿童采用氯喹单一疗法与青蒿琥酯联合氯喹疗法治疗非复杂性恶性疟原虫疟疾进行了比较。接受氯喹治疗的儿童28天临床失败率为15%（95%置信区间[CI]=9.2 - 22%），而接受联合疗法的儿童为11%（7.8 - 15%）（经威尔科克森检验，P = 0.08）。接受氯喹治疗的儿童中有73%在随访期间出现寄生虫血症，而接受联合疗法的儿童为49%（相对风险=1.5，95%CI = 1.3 - 1.7；卡方=21.18，P < 0.001）。联合治疗组在治疗后的前两周临床和寄生虫学治疗失败显著减少，但在随访的第三和第四周这种优势消失。文中讨论了联合疗法对耐氯喹寄生虫传播的影响。氯喹加青蒿琥酯的疗效不足以证明在冈比亚将其作为氯喹单一疗法的替代药物引入是合理的。
