Murphy S, English M, Waruiru C, Mwangi I, Amukoye E, Crawley J, Newton C, Winstanley P, Peshu N, Marsh K
Kenya Medical Research Institute, Kilifi.
Trans R Soc Trop Med Hyg. 1996 May-Jun;90(3):298-301. doi: 10.1016/s0035-9203(96)90260-6.
We have compared the efficacy of artemether versus quinine as treatment for cerebral malaria in children in an open randomized clinical trial in Kenya. Children admitted to hospital with coma and Plasmodium falciparum parasitaemia were treated with either intramuscular artemether (3.2 mg/kg loading dose followed by 1.6 mg/kg daily) or intravenous quinine (20 mg/kg loading dose followed by 10 mg/kg every 8 h). Both drugs were well tolerated and no significant adverse effect was observed. Parasite clearance times (50% and 90%) were shorter in patients treated with artemether (median times [h], with interquartile ranges in brackets, were: 50%, 7.3 [4.2-12.4] vs. 15.5 [9-22]; 90%, 16.9 [13.2-25] vs. 28.5 [22-35]; P < 0.0001). The total mortality in 160 children with cerebral malaria was 16.25%, with no overall significant difference between the 2 treatment groups. In a subgroup of children with respiratory distress, mortality was higher in those treated with artemether (43.7% vs. 11.1%, P < 0.05). The frequency of neurological sequelae and clinical recovery times were similar in both treatment groups. We conclude that there would currently be no advantage in replacing quinine with artemether for the treatment of cerebral malaria in African children.
在肯尼亚进行的一项开放性随机临床试验中，我们比较了蒿甲醚与奎宁治疗儿童脑型疟疾的疗效。因昏迷和恶性疟原虫血症入院的儿童，分别接受肌肉注射蒿甲醚（负荷剂量3.2mg/kg，随后每日1.6mg/kg）或静脉注射奎宁（负荷剂量20mg/kg，随后每8小时10mg/kg）治疗。两种药物耐受性均良好，未观察到显著不良反应。蒿甲醚治疗的患者寄生虫清除时间（50%和90%）较短（中位数时间[小时]，括号内为四分位间距，分别为：50%，7.3[4.2 - 12.4]对比15.5[9 - 22]；90%，16.9[13.2 - 25]对比28.5[22 - 35]；P < 0.0001）。160例脑型疟疾儿童的总死亡率为16.25%，两个治疗组之间总体无显著差异。在呼吸窘迫儿童亚组中，蒿甲醚治疗组的死亡率更高（43.7%对比11.1%，P < 0.05）。两个治疗组的神经后遗症发生率和临床恢复时间相似。我们得出结论，目前在非洲儿童脑型疟疾治疗中，用蒿甲醚替代奎宁并无优势。
