Looareesuwan S, Viravan C, Vanijanonta S, Wilairatana P, Suntharasamai P, Charoenlarp P, Arnold K, Kyle D, Canfield C, Webster K
Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Thailand.
Lancet. 1992 Apr 4;339(8797):821-4. doi: 10.1016/0140-6736(92)90276-9.
The increasing frequency of therapeutic failures in falciparum malaria in Thailand shows an urgent need for effective drugs or drug combinations. Artesunate, a qinghaosu derivative, is effective in clearing parasitaemia rapidly, but the recrudescence rate can be as high as 50%. We have compared artesunate followed by mefloquine with each drug alone in acute, uncomplicated falciparum malaria. 127 patients were randomly assigned treatment with artesunate (600 mg over 5 days), mefloquine (750 mg then 500 mg 6 h later), or artesunate followed by mefloquine. All patients were admitted to hospital for 28 days to exclude reinfection. Cure was defined as no recrudescence during the 28 days' follow-up. The cure rates for mefloquine and artesunate alone were 81% (30/37 patients) and 88% (35/40); the combination was effective in all of 39 patients. Fever and parasite clearance times were significantly shorter in the groups that received artesunate than in the mefloquine-only group. The frequency of nausea and vomiting was slightly, but not significantly, higher among patients who received both drugs than in the other groups. The combination of artesunate followed by mefloquine is highly effective and well tolerated in patients with acute, uncomplicated falciparum malaria in Thailand.
泰国恶性疟治疗失败频率的不断增加表明迫切需要有效的药物或药物组合。青蒿琥酯是一种青蒿素衍生物,能迅速清除疟原虫血症,但复发率可高达50%。我们比较了青蒿琥酯序贯甲氟喹与两种药物单用治疗急性非复杂性恶性疟的效果。127例患者被随机分配接受青蒿琥酯(5天内600毫克)、甲氟喹(750毫克,6小时后再服500毫克)或青蒿琥酯序贯甲氟喹治疗。所有患者住院28天以排除再感染。治愈定义为在28天随访期间无复发。单用甲氟喹和青蒿琥酯的治愈率分别为81%(37例患者中的30例)和88%(40例中的35例);联合用药组的39例患者全部治愈。接受青蒿琥酯治疗的组发热和疟原虫清除时间明显短于单用甲氟喹组。接受两种药物治疗的患者恶心和呕吐的发生率略高于其他组,但无显著差异。在泰国,青蒿琥酯序贯甲氟喹治疗急性非复杂性恶性疟患者疗效显著且耐受性良好。