Krudsood Srivicha, Tangpukdee Noppadon, Wilairatana Polrat, Phophak Nantaporn, Baird J Kevin, Brittenham Gary M, Looareesuwan Sornchai
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Am J Trop Med Hyg. 2008 May;78(5):736-40.
Plasmodium vivax causes debilitating but usually non-lethal malaria in most of Asia and South America. Prevention of relapse after otherwise effective therapy for the acute attack requires a standard daily dose of primaquine administered over 14 days. This regimen has < 90% efficacy in Thailand, and is widely regarded as ineffective because of poor compliance over the relatively long duration of dosing. We evaluated the efficacy, safety, and tolerability of alternative primaquine dosing regimens combined with artesunate among 399 Thai patients with acute, symptomatic P. vivax malaria. Patients were randomly assigned to one of six treatment groups: all patients received artesunate, 100 mg once a day for 5 days. Groups 1-5 then received primaquine, 30 mg a day for 5, 7, 9, 11, and 14 days, respectively. Group 6 received primaquine, 30 mg twice a day for 7 days. The 28-day cure rates were 85%, 89%, 94%, 100%, and 96%, respectively. Treatment of P. vivax malaria with artesunate for 5 days followed by high-dose primaquine, 30 mg twice a day for 7 days, was highly effective, well-tolerated, and equivalent or superior to the standard regimen of primaquine therapy.
间日疟原虫在亚洲大部分地区和南美洲引发使人虚弱但通常不致命的疟疾。对急性发作进行有效治疗后预防复发需要在14天内每日服用标准剂量的伯氨喹。该方案在泰国的疗效低于90%，由于在相对较长的给药期间依从性差，普遍被认为无效。我们评估了399例泰国急性、有症状间日疟原虫疟疾患者中，联合青蒿琥酯的替代伯氨喹给药方案的疗效、安全性和耐受性。患者被随机分配到六个治疗组之一：所有患者均接受青蒿琥酯，每日100mg，共5天。然后，第1 - 5组分别接受伯氨喹，每日30mg，共5、7、9、11和14天。第6组接受伯氨喹，每日两次，每次30mg，共7天。28天治愈率分别为85%、89%、94%、100%和96%。用青蒿琥酯治疗间日疟原虫疟疾5天，随后给予高剂量伯氨喹，每日两次，每次30mg，共7天，疗效显著，耐受性良好，等同于或优于伯氨喹治疗的标准方案。
