Nosten F, Luxemburger C, ter Kuile F O, Woodrow C, Eh J P, Chongsuphajaisiddhi T, White N J
Shoklo Malaria Research Unit, Mae Sot, Thailand.
J Infect Dis. 1994 Oct;170(4):971-7. doi: 10.1093/infdis/170.4.971.
Studies of 652 adults and children with acute uncomplicated falciparum malaria were done to determine the optimum treatment of multidrug-resistant Plasmodium falciparum malaria on the Thai-Burmese border. Single-dose artesunate (4 mg/kg) plus mefloquine (25 mg of base/kg) gave more rapid symptomatic and parasitologic responses than high-dose mefloquine alone but did not improve cure rates. Three days of artesunate (total dose, 10 mg/kg) plus mefloquine was 98% effective compared with a 28-day failure rate of 31% with high-dose mefloquine alone (relative risk [RR], 0.06; 95% confidence interval [CI], 0.02-0.2; P < .0001). By day 63, the reinfection adjusted failure rates were 2% and 44%, respectively (P < .0001). Artesunate also prevented high-grade failures. Both drugs were well tolerated. No adverse effects were attributable to artesunate. Vomiting was reduced significantly by giving mefloquine on day 2 of treatment (RR, 0.40; 95% CI, 0.20-0.79; P = .009. Artesunate (10 mg/kg over 3 days) plus mefloquine (25 mg/kg) is currently the most effective treatment for falciparum malaria in this area of increasing mefloquine resistance.
对652名患有急性非复杂性恶性疟的成人和儿童进行了研究，以确定泰国-缅甸边境地区耐多药恶性疟原虫疟疾的最佳治疗方法。单剂量青蒿琥酯（4毫克/千克）加甲氟喹（碱基25毫克/千克）比单独使用高剂量甲氟喹能产生更快的症状缓解和寄生虫学反应，但并未提高治愈率。与单独使用高剂量甲氟喹28天失败率为31%相比，三天的青蒿琥酯（总剂量10毫克/千克）加甲氟喹的有效率为98%（相对危险度[RR]，0.06；95%置信区间[CI]，0.02 - 0.2；P <.0001）。到第63天，重新感染调整后的失败率分别为2%和44%（P <.0001）。青蒿琥酯还可预防严重失败。两种药物耐受性良好。未发现与青蒿琥酯相关不良反应。在治疗第2天给予甲氟喹可显著减少呕吐（RR，0.40；95% CI，0.20 - 0.79；P =.009）。在甲氟喹耐药性不断增加的该地区，青蒿琥酯（3天内10毫克/千克）加甲氟喹（25毫克/千克）目前是治疗恶性疟最有效的方法。
