Wilairatana P, Kyle D E, Looareesuwan S, Chinwongprom K, Amradee S, White N J, Watkins W M
Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Thailand.
Ann Trop Med Parasitol. 1997 Mar;91(2):125-32.
Combinations of dapsone with proguanil or chlorproguanil have proved effective in the treatment of chloroquine-resistant falciparum malaria in Africa and for prophylaxis in Asia. These combinations have not been used for treatment in areas with multi-drug-resistant parasites such as in Thailand. Combinations of dapsone (approximately 4 mg/kg) plus ether proguanil (approximately 8 mg/kg; DP regimen; N = 10) or chlorproguanil (approximately 1.4 mg/kg; DC regimen; N = 16) were given once a day for 3 days to adult Thai patients with acute, uncomplicated, falciparum malaria. The two regimens were well tolerated and had no side-effects, but the cure rates, assessed at 28-day follow-up, were only 10% for DP (60% with RI response and 30% with RII) and 14% for DC (29% with RI response and 57% with RII). The mean (S.D.) fever-clearance times in those patients who were cured (S) or whose infections recrudesced (RI response) were 103 (56) h for those given DP and 90 (42) h for 6 those given DC. The corresponding parasite-clearance times were 83 (46) for DP and 53 (21) h for DC. In-vitro susceptibility testing of isolates obtained both before treatment and at recrudescence demonstrated marked resistance to cycloguanil, dapsone, chloroquine and mefloquine. The results demonstrate that short-course treatment with dapsone plus either proguanil or chlorproguanil is ineffective for the treatment of falciparum malaria in Thailand.
已证明氨苯砜与氯胍或氯丙胍联合使用对非洲氯喹耐药恶性疟的治疗以及亚洲的预防有效。这些联合用药尚未用于泰国等存在多重耐药寄生虫的地区的治疗。将氨苯砜（约4mg/kg）加乙氧氯胍（约8mg/kg；DP方案；N = 10）或氯丙胍（约1.4mg/kg；DC方案；N = 16）的联合用药方案每天给药1次，持续3天，用于治疗患有急性、非复杂性恶性疟的成年泰国患者。这两种方案耐受性良好且无副作用，但在28天随访时评估的治愈率，DP方案仅为10%（RI反应为60%，RII反应为30%），DC方案为14%（RI反应为29%，RII反应为57%）。治愈患者（S）或感染复发患者（RI反应）的平均（标准差）退热时间，接受DP方案治疗的患者为103（56）小时，接受DC方案治疗的患者为90（42）小时。相应的寄生虫清除时间，DP方案为83（46）小时，DC方案为53（21）小时。对治疗前和复发时获得的分离株进行的体外药敏试验表明，对环氯胍、氨苯砜、氯喹和甲氟喹有明显耐药性。结果表明，氨苯砜加氯胍或氯丙胍的短程治疗对泰国恶性疟的治疗无效。
