Bojang K A, Schneider G, Forck S, Obaro S K, Jaffar S, Pinder M, Rowley J, Greenwood B M
Medical Research Council Laboratories, Fajara, The Gambia.
Trans R Soc Trop Med Hyg. 1998 Jan-Feb;92(1):73-6. doi: 10.1016/s0035-9203(98)90962-2.
Chloroquine can no longer be recommended as the first-line treatment for uncomplicated malaria in several parts of Africa because of the increasing prevalence of chloroquine resistance. However, chloroquine was a highly effective treatment for malaria not only because of its ability to kill parasites quickly but also because it is an anti-inflammatory drug. Therefore, we have investigated whether Fansidar (pyrimethamine/sulfadoxine) plus chloroquine is a more effective treatment for uncomplicated malaria than Fansidar alone. Four hundred and five Gambian children with uncomplicated Plasmodium falciparum malaria were studied in a randomized controlled trial. Significantly more children treated with Fansidar alone, compared to those treated with Fansidar plus chloroquine (19/203 vs. 2/202; P < 0.001), returned to the clinic with persistent symptoms during the first 3 d after treatment. Three children who had received Fansidar alone had fits, but none of the children treated with Fansidar plus chloroquine did so. At the day 7 follow-up, the parasite failure rate in the Fansidar alone group was 3/198 (1.5%), whilst in the Fansidar plus chloroquine group it was 3/201 (1.5%). At the day 28 follow-up, there was still no significant difference between the parasite failure rate in the Fansidar alone group (15/150; 10.0%) and the Fansidar plus chloroquine group (7/141; 5.0%) and the mean packed cell volume (PCV) in the 2 groups was similar. Thus, a combination of Fansidar plus chloroquine was a more effective symptomatic treatment than Fansidar given alone, but neither the parasite cure rate nor the PCV was enhanced by use of the combination.
由于氯喹耐药性的日益普遍，在非洲的几个地区，氯喹不再被推荐作为非复杂性疟疾的一线治疗药物。然而，氯喹曾是一种非常有效的疟疾治疗药物，这不仅是因为它能迅速杀死疟原虫，还因为它是一种抗炎药物。因此，我们研究了Fansidar（乙胺嘧啶/磺胺多辛）加氯喹治疗非复杂性疟疾是否比单用Fansidar更有效。在一项随机对照试验中，对405名患有非复杂性恶性疟原虫疟疾的冈比亚儿童进行了研究。与接受Fansidar加氯喹治疗的儿童相比（2/202），单用Fansidar治疗的儿童在治疗后的头3天内症状持续并返回诊所的人数显著更多（19/203；P<0.001）。3名单用Fansidar治疗的儿童出现惊厥，但接受Fansidar加氯喹治疗的儿童均未出现。在第7天的随访中，单用Fansidar组的寄生虫清除失败率为3/198（1.5%），而Fansidar加氯喹组为3/201（1.5%）。在第28天的随访中，单用Fansidar组的寄生虫清除失败率（15/150；10.0%）与Fansidar加氯喹组（7/141；5.0%）之间仍无显著差异，两组的平均红细胞压积（PCV）相似。因此，Fansidar加氯喹联合治疗比单用Fansidar是一种更有效的对症治疗方法，但联合使用并未提高寄生虫治愈率或PCV。
