Kremsner P G, Winkler S, Brandts C, Neifer S, Bienzle U, Graninger W
International Research Laboratory, Albert-Schweitzer-Hospital, Lambaréné, Gabon.
J Infect Dis. 1994 Feb;169(2):467-70. doi: 10.1093/infdis/169.2.467.
Multidrug resistance of Plasmodium falciparum is becoming common in Africa. In a randomized trial, four short-term regimens were compared for treating uncomplicated P. falciparum malaria in children 4-15 years old in Gabon. One hundred thirty patients received chloroquine (25 mg/kg over 48 h; group C), chloroquine (as above) plus clindamycin (5 mg/kg every 12 h for 6 doses; group CCl), quinine (12 mg/kg every 12 h for 6 doses; group Q), or quinine (as above) plus clindamycin (as above; group QCl). In group C, only 9% of patients were cured by day 28, 44% showed recrudescent malaria (RI), and 47% showed intermediate or high-grade resistance (RII/RIII). In group CCl, 70% of patients were cured and 30% showed recrudescences. In group Q, 32% were cured and 68% showed recrudescences. In group QCl, 88% were cured and 12% showed recrudescences after day 14. All treatment regimens were well tolerated. Thus, the combination of clindamycin with chloroquine or quinine enhances parasite clearance and improves response to therapy.
恶性疟原虫的多重耐药性在非洲正变得普遍。在一项随机试验中，比较了四种短期治疗方案用于治疗加蓬4至15岁儿童的非复杂性恶性疟原虫疟疾。130名患者接受氯喹（48小时内25mg/kg；C组）、氯喹（如上）加克林霉素（每12小时5mg/kg，共6剂；CCl组）、奎宁（每12小时12mg/kg，共6剂；Q组）或奎宁（如上）加克林霉素（如上；QCl组）治疗。在C组中，到第28天只有9%的患者治愈，44%出现疟疾复发（RI），47%表现为中度或高度耐药（RII/RIII）。在CCl组中，70%的患者治愈，30%出现复发。在Q组中，32%的患者治愈，68%出现复发。在QCl组中，88%的患者治愈，14天后12%出现复发。所有治疗方案耐受性良好。因此，克林霉素与氯喹或奎宁联合使用可提高寄生虫清除率并改善治疗反应。
