Adebayo R A, Sofowora G G, Onayemi O, Udoh S J, Ajayi A A
Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
Br J Clin Pharmacol. 1997 Aug;44(2):157-61. doi: 10.1046/j.1365-2125.1997.00612.x.
Chloroquine treatment of malaria fever, results in a generalized pruritus of unknown mechanism in up to 60% of adult Africans, by contrast pruritus is unusual in Caucasians following chloroquine use.
We conducted a double-blind, randomized, parallel group study to examine and compare the antipruritic effects of promethazine, niacin, prednisolone and their combination on pruritus induced by chloroquine, in 28 historical itching patients with parasitologically proven malaria fever. We also evaluated the role of the antecedent malaria parasite density in the severity of chloroquine pruritus intensity.
The concurrent administration of chloroquine (2.1 g base total dose) with prednisolone caused a statistically significant reduction in the pruritus AUC (0, 72 h) (P < 0.001 ANOVA) compared with the antihistamine promethazine alone. The areas under the pruritus intensity-time curve were promethazine 105 +/- 28 (units h), niacin 76 +/- 22, prednisolone 28 +/- 24, and prednisolone and niacin 34 +/- 17 (P < 0.001 ANOVA). The 95% confidence interval for the difference in the pruritus AUC between prednisolone and promethazine was 8.4 to 145.6 units h. There was a statistically significant and positive correlation between the pruritus intensity (AUC 0, 72 h) and the malaria parasite load in the itching subjects, not receiving prednisolone (n = 9) (r = 0.73, P = 0.026 ANOVA).
A single oral dose of prednisolone (10 mg) may be preferable to the antihistamine promethazine (25 mg) as an antipruritic agent for concurrent prescription with chloroquine in individuals predisposed to severe itching. Malaria parasite clearance and clinical amelioration were unaffected by any of the treatments.
氯喹治疗疟疾发热时，高达60%的成年非洲人会出现机制不明的全身性瘙痒，相比之下，高加索人使用氯喹后瘙痒并不常见。
我们进行了一项双盲、随机、平行组研究，以检查和比较异丙嗪、烟酸、泼尼松龙及其组合对28例经寄生虫学证实患有疟疾发热的既往有瘙痒症状患者氯喹诱发瘙痒的止痒效果。我们还评估了先前疟原虫密度在氯喹瘙痒强度严重程度中的作用。
与单独使用抗组胺药异丙嗪相比，氯喹（总剂量2.1 g碱）与泼尼松龙同时给药导致瘙痒AUC（0，72小时）有统计学显著降低（方差分析P<0.001）。瘙痒强度-时间曲线下面积分别为：异丙嗪105±28（单位·小时）、烟酸76±22、泼尼松龙28±24、泼尼松龙与烟酸组合34±17（方差分析P<0.001）。泼尼松龙和异丙嗪之间瘙痒AUC差异的95%置信区间为8.4至145.6单位·小时。在未接受泼尼松龙的瘙痒受试者（n = 9）中，瘙痒强度（AUC 0，72小时）与疟原虫载量之间存在统计学显著的正相关（r = 0.73，方差分析P = 0.026）。
对于有严重瘙痒倾向的个体，单剂量口服泼尼松龙（10 mg）作为与氯喹同时处方的止痒剂可能比抗组胺药异丙嗪（25 mg）更可取。任何一种治疗均未影响疟原虫清除和临床改善情况。
