Effect of paracetamol on parasite clearance time in Plasmodium falciparum malaria
Effect of paracetamol on parasite clearance time in Plasmodium falciparum malaria
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DOI：
10.1016/s0140-6736(97)02255-1
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发表时间：
1997-09-06
期刊：
影响因子：
168.9
通讯作者：
Kremsner, PG
中科院分区：
文献类型：
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作者：
Brandts, CH;Ndjave, M;Kremsner, PG
背景儿童感染性疾病的常规退热治疗长期以来一直是争议的来源。每年，除了抗疟疾药物外，数百万患有恶性疟疾的儿童还会接受扑热息痛退烧。方法在加蓬兰巴伦进行的一项随机试验中，50名患有恶性疟疾的儿童接受了奎宁静脉注射治疗，并接受了单独的机械解热或与扑热息痛联合治疗。每6h记录一次直肠体温和寄生虫血症，连续4d。每24小时检测一次血浆肿瘤坏死因子和白介素6的浓度，并测定氧自由基的产生。结果显示，接受扑热息痛治疗的儿童平均退热时间为32h，而单纯机械解热治疗的平均退热时间为43h，但这11h的差异无统计学意义(95%CI-2~24 h；p=0.176)。服用扑热息痛的患者寄生虫清除时间明显延长，相差16小时(8-24小时；P=0.004)。在研究过程中，两组患者的血浆肿瘤坏死因子和白介素6浓度相似。然而，在接受扑热息痛治疗的儿童中，肿瘤坏死因子的诱导浓度和氧自由基的产生显著低于接受机械解热治疗的儿童。这些数据表明，在恶性疟疾中，扑热息痛并不比单独机械解热有解热作用。此外，扑热息痛可能通过减少肿瘤坏死因子和氧自由基的产生来延长寄生虫的清除时间。
Background Routine antipyretic therapy in children with infectious diseases has long been the source of controversy. Each year, in addition to antimalarial medication, millions of children with Plasmodium falciparum malaria receive paracetamol to reduce fever. However, the usefulness of this practice has not been proven.Methods In a randomised trial in Lambarene, Gabon, 50 children with P falciparum malaria were treated with intravenous quinine, and received either mechanical antipyresis alone, or in combination with paracetamol. Rectal body temperature and parasitaemia were recorded every 6 h for 4 days. Plasma concentrations and inducible concentrations of tumour necrosis factor (TNF) and interleukin-6 were measured every 24 h. In addition, production of oxygen radicals was measured in both groups.Findings The mean fever clearance time was 32 h for children treated with paracetamol and 43 h for those who received mechanical antipyresis alone; however, this 11 h difference was not significant (95% CI -2 to 24 h; p=0.176). Parasite clearance time was significantly prolonged in patients who received paracetamol with a difference of 16 h (8-24 h; p=0.004). Plasma concentrations of TNF and interleukin-6 were similar in both groups during the study. However, the induced concentrations of TNF, and the production of oxygen radicals, were significantly lower in children treated with paracetamol than those who received mechanical antipyresis alone.Interpretation These data suggest that paracetamol has no antipyretic benefits over mechanical antipyresis alone in P falciparum malaria. Moreover, paracetamol prolongs parasite clearance time, possibly by decreased production of TNF and oxygen radicals.