van den Broek I V, Maung U A, Peters A, Liem L, Kamal M, Rahman M, Rahman M R, Bangali A M, Das S, Barends M, Faiz A M
MSF-UK, London, UK.
Trans R Soc Trop Med Hyg. 2005 Oct;99(10):727-35. doi: 10.1016/j.trstmh.2005.02.007.
Bangladesh faces growing levels of Plasmodium falciparum resistance to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP). Alternative antimalarial therapies, particularly combination regimens, need to be considered. Therefore, the efficacy of three antimalarial combination therapies was assessed in Chittagong Hill Tracts. A total of 364 P. falciparum patients were recruited and randomly assigned to either CQ + SP, mefloquine + artesunate (MQ + AS) or lumefantrine + artemether (Coartem). Results showed that CQ + SP therapy was less effective than the two artemisinin-based combination therapies. The day 42 PCR-corrected efficacy rate was 62.4% for CQ + SP, 100% for MQ + AS and 97.1% for Coartem. Failures occurred at a shorter interval after CQ + SP treatment than after Coartem. The artemisinin-based therapies effectively prevented development of gametocytes, whereas CQ + SP did not. All three therapies were well tolerated, although reports of mild complaints during treatment appeared higher with MQ + AS. We conclude that CQ + SP is not a viable option for replacing CQ monotherapy as first-line P. falciparum treatment in this area of Bangladesh. A change to artemisinin-based combination therapy is recommended. Both Coartem and MQ + AS appear to be good options, effective in curing P. falciparum malaria and in preventing recrudescences following treatment.
孟加拉国面临着恶性疟原虫对氯喹（CQ）和磺胺多辛-乙胺嘧啶（SP）耐药性不断增加的问题。需要考虑使用替代抗疟疗法，特别是联合用药方案。因此，在吉大港山区评估了三种抗疟联合疗法的疗效。总共招募了364名恶性疟原虫患者，并将他们随机分为接受CQ+SP、甲氟喹+青蒿琥酯（MQ+AS）或双氢青蒿素哌喹（科泰复）治疗。结果显示，CQ+SP疗法的效果不如两种以青蒿素为基础的联合疗法。CQ+SP疗法在第42天经PCR校正后的有效率为62.4%，MQ+AS为100%，科泰复为97.1%。CQ+SP治疗后出现失败的间隔时间比科泰复治疗后短。以青蒿素为基础的疗法能有效防止配子体的发育，而CQ+SP则不能。尽管在治疗期间，MQ+AS出现轻微不适的报告似乎较多，但所有三种疗法的耐受性都良好。我们得出结论，在孟加拉国的这一地区，CQ+SP不是替代CQ单药疗法作为一线恶性疟原虫治疗的可行选择。建议改用以青蒿素为基础的联合疗法。科泰复和MQ+AS似乎都是很好的选择，它们在治愈恶性疟原虫疟疾以及预防治疗后复发方面都很有效。
