Murphy G S, Basri H, Andersen E M, Bangs M J, Mount D L, Gorden J, Lal A A, Purwokusumo A R, Harjosuwarno S
US Naval Medical Research Unit No 2, Jakarta, Indonesia.
Lancet. 1993 Jan 9;341(8837):96-100. doi: 10.1016/0140-6736(93)92568-e.
Chloroquine has been the treatment of choice for vivax malaria for more than 40 years. Lately, several case-reports have suggested the emergence of resistance to chloroquine in Plasmodium vivax in Papua New Guinea and Indonesia. We undertook prospective treatment and prophylaxis trials of chloroquine in children and adults with vivax malaria living in Irian Jaya (Indonesia New Guinea). 46 villagers with P vivax parasitaemia were treated with chloroquine by mouth (25 mg base/kg body weight divided over 3 days) and followed up for 14 days. Parasitaemia cleared initially but recurred within 14 days in 10 (22%) subjects. All recurrences were in children younger than 11 years, 7 of whom were younger than 4 years; the failure rate among children under 4 was 70%. 7 of the patients with recurrences were given a second course of chloroquine. In all, the infections initially cleared but recurrent parasitaemia developed in 5 (71%) within 14 days. Whole-blood chloroquine concentrations were consistently above those previously shown to cure P vivax blood infections (90 micrograms/L whole blood). Subjects whose initial infections cleared and who had no parasitaemia on day 14 received weekly prophylaxis with chloroquine. Despite the presence of expected blood chloroquine concentrations, P vivax parasitaemia developed in 9 of 17 subjects receiving prophylaxis during 8 weeks of follow-up (median time to parasitaemia 5.3 weeks). Chloroquine can no longer be relied upon for effective treatment or chemoprophylaxis of P vivax blood infections acquired in this part of New Guinea.
40多年来，氯喹一直是间日疟的首选治疗药物。最近，一些病例报告表明，巴布亚新几内亚和印度尼西亚的间日疟原虫出现了对氯喹的耐药性。我们对居住在伊里安查亚（印度尼西亚新几内亚）的间日疟儿童和成人进行了氯喹的前瞻性治疗和预防试验。46名间日疟原虫血症的村民口服氯喹（25mg碱基/千克体重，分3天服用），并随访14天。寄生虫血症最初清除，但10名（22%）受试者在14天内复发。所有复发者均为11岁以下儿童，其中7名年龄小于4岁；4岁以下儿童的失败率为70%。7名复发患者接受了第二疗程的氯喹治疗。总体而言，感染最初清除，但5名（71%）在14天内出现复发寄生虫血症。全血氯喹浓度一直高于先前显示可治愈间日疟原虫血液感染的浓度（全血90微克/升）。初始感染清除且在第14天无寄生虫血症的受试者每周接受氯喹预防。尽管存在预期的血液氯喹浓度，但在8周的随访期间，17名接受预防的受试者中有9名出现了间日疟原虫血症（出现寄生虫血症的中位时间为5.3周）。在新几内亚的这一地区，氯喹已不能再可靠地用于间日疟原虫血液感染的有效治疗或化学预防。
