Looareesuwan S, Kyle D E, Viravan C, Vanijanonta S, Wilairatana P, Charoenlarp P, Canfield C J, Webster H K
Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University.
Am J Trop Med Hyg. 1992 Dec;47(6):794-9. doi: 10.4269/ajtmh.1992.47.794.
A sequential combination of artesunate followed by mefloquine was evaluated prospectively in 24 patients with acute recrudescent falciparum malaria. The sequential combination was used to minimize possible side effects and to take advantage of the ability of artesunate to rapidly clear parasitemia and the prolonged effect of mefloquine to clear residual parasites. All patients had experienced one or more treatment failures with one or more courses of the following drugs (administered alone or in combination): quinine, tetracycline, mefloquine, artesunate, and sulfadoxine/pyrimethamine. Sequential treatment with artesunate (600 mg over five days) followed by mefloquine (750 mg and 500 mg six hours apart) cured all 24 patients. Each patient was followed for 28 days and 10 were observed for at least 35 days without clinical or parasitologic evidence of recrudescence. Fever and parasite clearance times after treatment with the sequential combination were 32.8 +/- 19.3 hr (mean +/- SD) and 40.0 +/- 16.2 hr, respectively. Susceptibility testing of selected parasite isolates indicated that all of the isolates tested were resistant to one or more antimalarial drugs. These results suggest that sequential treatment with artesunate followed by mefloquine is effective and well-tolerated in patients with recrudescent falciparum malaria.
对24例急性恶性疟再燃患者前瞻性评估了青蒿琥酯序贯联合甲氟喹的疗效。采用序贯联合用药旨在尽量减少可能的副作用，并利用青蒿琥酯迅速清除疟原虫血症的能力以及甲氟喹清除残留疟原虫的长效作用。所有患者均曾接受过以下一种或多种药物（单独或联合使用）的一个或多个疗程治疗但出现了一次或多次治疗失败：奎宁、四环素、甲氟喹、青蒿琥酯以及磺胺多辛/乙胺嘧啶。采用青蒿琥酯（5天内600毫克）序贯甲氟喹（750毫克和500毫克，间隔6小时）治疗使所有24例患者均获治愈。对每名患者随访28天，其中10例观察至少35天，均无复发的临床或寄生虫学证据。序贯联合治疗后发热和疟原虫清除时间分别为32.8 +/- 19.3小时（均值 +/-标准差）和40.0 +/- 16.2小时。对选定疟原虫分离株的药敏试验表明，所有受试分离株均对一种或多种抗疟药物耐药。这些结果提示，青蒿琥酯序贯甲氟喹治疗对恶性疟再燃患者有效且耐受性良好。
