Response of uncomplicated falciparum malaria to oral chloroquine and quinine in Burundi highlands
Response of uncomplicated falciparum malaria to oral chloroquine and quinine in Burundi highlands
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DOI：
10.1016/s0001-706x(98)00010-2
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发表时间：
1998-06-15
期刊：
影响因子：
2.7
通讯作者：
Concia, E
中科院分区：
文献类型：
--
作者：
Di Perri, G;Olliaro, P;Concia, E
恶性疟疾对口服氯喹和奎宁的体内反应在两项相同的医院比较开放试验中进行了评估，这两项试验相隔两年，在同一季节期间在布隆迪北部高地的一家医院进行。患有无并发症恶性疟疾的 0-14 岁儿童接受氯喹（25 毫克/公斤，持续 3 天）或奎宁（10 毫克/公斤，每 8 小时一次，持续 5 天）（交替分配），并通过 WHO 7 天测试评估治疗反应。在第一项研究（1992/1993）中，有 472 名患者符合分析资格（氯喹组 211 名，奎宁组 261 名），而第二项研究（1994/1995）中有 249 名受试者。在每项研究中，对奎宁的反应均显着高于对氯喹的反应（分别为 P = 0.004 和 < 0.001）。虽然奎宁的反应随着时间的推移显示出不显着的变化（95.8 vs. 92.9%），但在第二项研究中发现氯喹的效果明显低于第一项研究（77.8 vs. 63.1%；OR (95% CI) 2.04 (1.21-3.43)）。氯喹功效的下降归因于<5岁的年龄组，该年龄组对氯喹的反应从1992/1993年的72.9%下降到1994/1995年的56%。 1993 年底仍在持续的种族冲突爆发后，不受控制的氯喹使用蔓延，似乎是氯喹疗效下降的最可能原因。人们早就知道布隆迪高流行低地地区存在氯喹耐药性，但迄今为止还没有关于该国高地地区抗疟药反应的数据报告。在决定布隆迪治疗恶性疟疾的药物政策时应考虑这些发现。 (C) 1998 Elsevier Science B.V. 保留所有权利。
The in vivo response of falciparum malaria to oral chloroquine and quinine was evaluated in two identical hospital-based, comparative open trials carried out 2 years apart in the same seasonal period at a hospital located in the highlands of Northern Burundi. Children aged 0-14 with uncomplicated falciparum malaria were administered either chloroquine, at 25 mg/kg over 3 days, or quinine, at 10 mg/kg per 8 hourly for 5 days (alternate allocation) and treatment response was evaluated by the WHO 7-day test. In the first study (1992/1993) 472 patients qualified for analyses (211 in the chloroquine and 261 in the quinine group), as compared to 249 subjects in the second study (1994/1995). In each study, the response to quinine was significantly higher than that to chloroquine (P = 0.004 and < 0.001, respectively). While the response to quinine showed insignificant changes over time (95.8 vs. 92.9%), chloroquine was found to be significantly less effective in the second study as compared to the first (77.8 vs. 63.1%; OR (95% CI) 2.04 (1.21-3.43)). Such decline in chloroquine efficacy was attributable to the age group < 5 years of age, where response to chloroquine decreased from 72.9% in 1992/93 to 56% in 1994/1995. Uncontrolled chloroquine use, which spread after the onset in late 1993 of the still ongoing ethnic fighting, appears to be the most likely reason for such a decrease in chloroquine efficacy. Chloroquine resistance has long been known to be present in the hyperendemic lowlands of Burundi, but no data have so far been reported on the response to antimalarials in the highlands of the country. These findings should be considered when deciding on drug policies for the treatment of falciparum malaria in Burundi. (C) 1998 Elsevier Science B.V. All rights reserved.