al-Yaman F, Genton B, Mokela D, Narara A, Raiko A, Alpers M P
Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
P N G Med J. 1996 Mar;39(1):16-22.
The in vivo response of Plasmodium falciparum parasites to amodiaquine or chloroquine was assessed in children with symptomatic malaria attending different health facilities in the Madang area. Among the 27 subjects who were completely followed up, 4 (15%) were infected with parasites fully susceptible and 23 (85%) with parasites exhibiting some degree of resistance. Out of the latter group, 52% were of RI level, 26% RII and 22% RIII. 14 subjects out of 42 (33%) failed to clear their parasitaemia by day 7 and 92 out of 134 (69%) had persistent or recrudescent parasitaemia at day 21. The level of in vivo resistance was similar for amodiaquine and chloroquine. 86% of the isolates tested in vitro showed resistance to amodiaquine, 86% to chloroquine and 7% to quinine. In ten years the prevalence of resistant isolates in vivo has increased from 47% to 85%. Of more concern is the shift from RI level of resistance to RII and RIII: the proportion of resistant strains that were RI dropped from 90% to 52% over the ten-year period. To determine if the standard antimalarial regimens are still appropriate, there is a need not only to assess the level of parasite resistance but also the prevalence of treatment failure in different parts of Papua New Guinea.
在马当地区不同医疗机构就诊的有症状疟疾儿童中，评估了恶性疟原虫对阿莫地喹或氯喹的体内反应。在27名得到完全随访的受试者中，4名（15%）感染的是对药物完全敏感的疟原虫，23名（85%）感染的是表现出某种程度耐药性的疟原虫。在后一组中，52%为RI级，26%为RII级，22%为RIII级。42名受试者中有14名（33%）在第7天未能清除血中疟原虫，134名中有92名（69%）在第21天有持续性或复发性血中疟原虫。阿莫地喹和氯喹的体内耐药水平相似。体外检测的分离株中，86%对阿莫地喹耐药，86%对氯喹耐药，7%对奎宁耐药。十年间，体内耐药分离株的流行率从47%增至85%。更令人担忧的是耐药水平从RI级向RII级和RIII级的转变：十年间，RI级耐药菌株的比例从90%降至52%。为确定标准抗疟治疗方案是否仍然适用，不仅需要评估疟原虫的耐药水平，还需要评估巴布亚新几内亚不同地区治疗失败的发生率。
