Kimura Mikio, Koga Michiko, Kikuchi Tadashi, Miura Toshiyuki, Maruyama Haruhiko
Department of Internal Medicine, Shin-Yamanote Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
Parasitol Int. 2012 Sep;61(3):466-9. doi: 10.1016/j.parint.2012.03.004. Epub 2012 Mar 29.
Malaria remains an important health risk among travelers to tropical/subtropical regions. However, in Japan, only 2 antimalarials are licensed for clinical use - oral quinine and mefloquine. The Research Group on Chemotherapy of Tropical Diseases introduced atovaquone-proguanil in 1999, and reported on its excellent antimalarial efficacy and safety for treating non-immune patients with uncomplicated Plasmodium falciparum malaria (20 adult and 3 pediatric cases) in 2006. In the present study, additional cases of malaria were analyzed to confirm the efficacy and safety of this antimalarial drug. Fourteen adult and 2 pediatric cases of P. falciparum malaria and 13 adult cases and 1 pediatric case of P. vivax/ovale malaria were successfully treated with atovaquone-proguanil, including 3 P. falciparum cases in which the antecedent treatment failed. Two patients with P. vivax malaria were treated twice due to primaquine treatment failure as opposed to atovaquone-proguanil treatment failure. Except for 1 patient with P. falciparum malaria who developed a moderate liver function disturbance, no significant adverse effects were observed. Despite the intrinsic limitations of this study, which was not a formal clinical trial, the data showed that atovaquone-proguanil was an effective and well-tolerated therapeutic option; licensure of this drug in Japan could greatly contribute to individually appropriate treatment options.
疟疾对于前往热带/亚热带地区的旅行者而言，仍然是一项重大的健康风险。然而，在日本，仅有两种抗疟药被批准用于临床——口服奎宁和甲氟喹。热带病化疗研究小组于1999年引入了阿托伐醌-氯胍，并于2006年报告了其在治疗非免疫性单纯恶性疟原虫疟疾患者（20例成人和3例儿童）方面具有出色的抗疟疗效和安全性。在本研究中，对更多疟疾病例进行了分析，以确认这种抗疟药物的疗效和安全性。14例成人和2例儿童的恶性疟原虫疟疾病例以及13例成人和1例儿童的间日疟原虫/卵形疟原虫疟疾病例成功接受了阿托伐醌-氯胍治疗，其中包括3例先前治疗失败恶性疟原虫病例。2例间日疟原虫疟疾患者因伯氨喹治疗失败而非阿托伐醌-氯胍治疗失败而接受了两次治疗。除1例出现中度肝功能障碍的恶性疟原虫疟疾患者外，未观察到明显的不良反应。尽管本研究存在固有的局限性（并非正式临床试验），但数据表明阿托伐醌-氯胍是一种有效且耐受性良好的治疗选择；该药物在日本获得批准可能会极大地有助于提供个性化的合适治疗方案。
