Swiss Tropical and Public Health Institute, Basel, Switzerland.
Clin Infect Dis. 2013 May;56(10):1413-20. doi: 10.1093/cid/cit068. Epub 2013 Feb 12.
Artemisinin combination therapy is recommended as treatment for uncomplicated Plasmodium falciparum (Pf) malaria, whereas chloroquine is still widely used for non-Pf infections. A common treatment for both vivax and falciparum malaria would be welcome.
A longitudinal prospective effectiveness study of 1682 children aged 3-27 months in outpatient clinics in Papua New Guinea. The main outcome was clinical treatment failure rate following treatment with artemether/lumefantrine (AL).
Among 5670 febrile episodes, 1682 (28%) had positive rapid diagnostic test (RDT) results and were treated with AL. A total of 1261 (22%) had an infection confirmed by blood slide examination. Of these, 594 Pv and 332 Pf clinical malaria cases were included in the primary effectiveness analysis. Clinical treatment failure rates at 7, 28, and 42 days were 0.2%, 2.2%, and 12.0%, respectively, for Pv and 0.3%, 1.2%, and 3.6%, respectively, for Pf. A single malaria-unrelated death occurred within 42 days following treatment with AL, in a child who was aparasitemic by blood slide at reattendance.
AL provides a rapid clinical response against both Pf and Pv malaria, but is associated with a high rate of Pv recurrent clinical episodes between days 28 and 42. In order to prevent relapsing infections from long-lasting hypnozoites, AL should ideally be complemented with a course of primaquine. In the absence of better treatment and diagnostic options, the use of AL in young children in routine practice is an acceptable, interim option in coendemic areas where Pv is resistant to chloroquine and specific treatment for Pv hypnozoites not feasible.
青蒿素联合疗法被推荐用于治疗无并发症的恶性疟原虫（Pf）疟疾，而氯喹仍广泛用于非 Pf 感染。对于间日疟原虫和恶性疟原虫，一种通用的治疗方法将是受欢迎的。
在巴布亚新几内亚的门诊诊所对 1682 名 3-27 个月大的儿童进行了一项纵向前瞻性有效性研究。主要结局是使用青蒿琥酯/咯萘啶（AL）治疗后的临床治疗失败率。
在 5670 个发热病例中，有 1682 个（28%）快速诊断检测（RDT）结果阳性，并接受 AL 治疗。共有 1261 个（22%）通过血片检查确认感染。其中，594 个 Pv 和 332 个 Pf 临床疟疾病例被纳入主要有效性分析。Pv 的 7、28 和 42 天临床治疗失败率分别为 0.2%、2.2%和 12.0%，Pf 分别为 0.3%、1.2%和 3.6%。在接受 AL 治疗后 42 天内，发生了一例与疟疾无关的单一死亡，该患儿在复诊时血片中无寄生虫。
AL 对 Pf 和 Pv 疟疾均能迅速产生临床反应，但在 28 至 42 天之间，Pv 再次出现临床发作的比例较高。为了防止来自持久休眠子的复发性感染，AL 理想情况下应辅以伯氨喹治疗。在缺乏更好的治疗和诊断选择的情况下，在 Pf 对氯喹耐药且无法实施针对 Pf 休眠子的具体治疗的共流行地区，AL 在常规实践中用于儿童是一种可接受的临时选择。
