Malaria Research Unit, CNRS UMR 5246, University Lyon 1, Faculty of Medicine, Lyon, France.
Malar J. 2012 Oct 19;11:347. doi: 10.1186/1475-2875-11-347.
In Guyana, chloroquine + primaquine is used for the treatment of vivax malaria. A worldwide increase of chloroquine resistance in Plasmodium vivax led to questioning of the current malaria treatment guidelines. A therapeutic efficacy study was conducted using artemether-lumefantrine + primaquine against P. vivax to evaluate a treatment alternative for chloroquine.
From 2009 to 2010, a non-controlled study in two hospitals in Guyana was conducted. A total 61 patients with P. vivax infection were treated with artemether-lumefantrine as a six-dose regimen twice a day for three days with additional 0.25 mg/kg/d primaquine at day 0 for 14 days. Clinical and parasitological parameters were followed on days 0,1,2,3,7,14 and 28 in agreement with WHO guidelines. Plasmodium vivax DNA from eight patients was analysed for pvmdr1, molecular marker of resistance.
Artemether-lumefantrine cleared 100% of parasites on day 1, but two patients (3%) had recurrence of parasites on day 28, suggesting relapse. No pvmdr1 Y976F polymorphism was detected. The treatment regimen was well tolerated.
In Guyana, artemether-lumefantrine represents an adequate treatment option against P. vivax when combined with primaquine. Availability of this alternative will be of great importance in case of emerging chloroquine resistance against P. vivax.
在圭亚那，氯喹+伯氨喹用于治疗间日疟。由于全球范围内间日疟原虫对氯喹的耐药性增加，人们对当前的疟疾治疗指南提出了质疑。本研究采用青蒿琥酯-咯萘啶+伯氨喹治疗间日疟原虫，以评估一种替代氯喹的治疗方法。
2009 年至 2010 年，在圭亚那的两家医院进行了一项非对照研究。61 例间日疟患者采用青蒿琥酯-咯萘啶 6 天疗法，每日两次，连续 3 天，第 0 天加用 0.25mg/kg/d 伯氨喹，共 14 天。按照世界卫生组织的指导原则，在第 0、1、2、3、7、14 和 28 天监测临床和寄生虫学参数。根据 pvmdr1 分析 8 例患者的间日疟原虫 DNA，该基因是耐药的分子标志物。
青蒿琥酯-咯萘啶在第 1 天清除了 100%的寄生虫，但有 2 例患者（3%）在第 28 天寄生虫复发，提示为再燃。未检测到 pvmdr1 Y976F 多态性。该治疗方案耐受性良好。
在圭亚那，青蒿琥酯-咯萘啶联合伯氨喹是治疗间日疟的有效选择。如果出现间日疟原虫对氯喹的耐药性，这种替代方案的可用性将非常重要。
