Price R, Luxemburger C, van Vugt M, Nosten F, Kham A, Simpson J, Looareesuwan S, Chongsuphajaisiddhi T, White N J
Shoklo Malaria Research Unit, Mae Sod, Tak Province, Thailand.
Trans R Soc Trop Med Hyg. 1998 Mar-Apr;92(2):207-11. doi: 10.1016/s0035-9203(98)90750-7.
Oral artesunate is the most effective treatment for uncomplicated hyperparasitaemia in falciparum malaria. To assess the contribution of mefloquine to therapeutic efficacy in an area endemic for mefloquine-resistant Plasmodium falciparum, an open randomized comparison of a 5 d course of oral artesunate (total dose 12 mg/kg) with and without a single dose of mefloquine (25 base mg/kg) was conducted in 100 adults and children with uncomplicated hyperparasitaemia (> 4% parasitized red blood cells). Both regimens were well tolerated and gave equally rapid clinical responses (84% of patients were aparasitaemic and 96% were afebrile within 48 h), but the recrudescence rate assessed at day 42 was 6% in those receiving artesunate with mefloquine compared to 36% in those receiving artesunate alone (adjusted hazard ratio 7, 95% confidence interval [95% CI] 2-32; P < 0.01). In addition, the efficacy of a 7 d course of artesunate, with and without the addition of mefloquine, was monitored in 178 patients who were not part of the randomized comparison. The failure rate was again lower in those receiving artesunate and mefloquine--7% (95% CI 2-13) compared with 26% (95% CI 8-44) in patients treated with artesunate alone. An oral regimen of 5 d or more of artesunate, together with mefloquine (25 mg/kg) given on day 2, is an effective treatment for uncomplicated hyperparasitaemic falciparum malaria in this area of high level multidrug resistance.
口服青蒿琥酯是治疗恶性疟原虫单纯性高疟原虫血症最有效的方法。为评估甲氟喹在耐甲氟喹恶性疟原虫流行地区对治疗效果的贡献，对100例患有单纯性高疟原虫血症（>4%的寄生红细胞）的成人和儿童进行了一项开放性随机对照试验，比较了5天疗程的口服青蒿琥酯（总剂量12mg/kg）加或不加单剂量甲氟喹（25mg碱基/kg）的疗效。两种治疗方案耐受性均良好，临床反应同样迅速（84%的患者在48小时内疟原虫血症消失，96%的患者退热），但在第42天评估的复发率，接受青蒿琥酯加甲氟喹治疗的患者为6%，而单独接受青蒿琥酯治疗的患者为36%（校正风险比7，95%置信区间[95%CI]2 - 32；P<0.01）。此外，在178例未参与随机对照试验的患者中监测了7天疗程的青蒿琥酯加或不加甲氟喹的疗效。接受青蒿琥酯加甲氟喹治疗的患者失败率同样较低——为7%（95%CI 2 - 13），而单独接受青蒿琥酯治疗的患者为26%（95%CI 8 - 44）。在这个多药耐药水平较高的地区，5天或更长疗程的青蒿琥酯口服方案，加上第2天给予的甲氟喹（25mg/kg），是治疗单纯性高疟原虫血症恶性疟的有效方法。
