Price R N, Nosten F, Luxemburger C, Kham A, Brockman A, Chongsuphajaisiddhi T, White N J
Shoklo Malaria Research Unit, Tak Province, Thailand.
Trans R Soc Trop Med Hyg. 1995 Sep-Oct;89(5):523-7. doi: 10.1016/0035-9203(95)90094-2.
To compare the therapeutic efficacy of oral artesunate and artemether in combination with mefloquine for the treatment of multidrug resistant malaria, a trial was conducted in 540 adults and children on the Thai-Myanmar border. Three regimens were compared: artesunate (4 mg/kg/d for 3 d), artemether (4 mg/kg/d for 3 d), both in combination with mefloquine (25 mg/kg), and a single dose of mefloquine (25 mg/kg). The artesunate and artemether regimens gave very similar clinical and parasitological responses, and were both very well tolerated. There was no significant adverse effect attributable to the artemisinin derivatives. Fever and parasite clearance times with mefloquine alone were significantly longer (P < 0.001). After adjusting for reinfections the failure rates were 13.9% for the artesunate combination, 12.3% for the artemether combination and 49.2% for mefloquine alone (P < 0.0001; relative risk 3.8 [95% confidence interval 2.6-5.4]). Mefloquine should no longer be used alone for the treatment of multidrug resistant falciparum malaria in this area. Three-day combination regimens with artesunate or artemether are well tolerated and more effective.
为比较口服青蒿琥酯和蒿甲醚联合甲氟喹治疗多重耐药疟疾的疗效，在泰国-缅甸边境对540名成人和儿童进行了一项试验。比较了三种治疗方案：青蒿琥酯（4毫克/千克/天，共3天）、蒿甲醚（4毫克/千克/天，共3天），二者均联合甲氟喹（25毫克/千克），以及单剂量甲氟喹（25毫克/千克）。青蒿琥酯和蒿甲醚方案产生了非常相似的临床和寄生虫学反应，且耐受性均良好。未发现青蒿素衍生物有显著不良反应。单独使用甲氟喹时，发热和寄生虫清除时间显著更长（P<0.001）。在对再感染进行校正后，青蒿琥酯联合用药的失败率为13.9%，蒿甲醚联合用药为12.3%，单独使用甲氟喹为49.2%（P<0.0001；相对风险3.8[95%置信区间2.6-5.4]）。在该地区，甲氟喹不应再单独用于治疗多重耐药恶性疟。青蒿琥酯或蒿甲醚的三日联合治疗方案耐受性良好且更有效。
