Artesunate, artemether or quinine in severe Plasmodium falciparum malaria?
Artesunate, artemether or quinine in severe Plasmodium falciparum malaria?
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DOI：
10.1586/14787210.5.2.199
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发表时间：
2007-04-01
影响因子：
5.7
通讯作者：
Whitty, Christopher J. M.
中科院分区：
文献类型：
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作者：
Checkly, Anna M.;Whitty, Christopher J. M.
奎宁和青蒿素衍生物药物青蒿琥酯和蒿甲醚是治疗严重恶性疟疾的有效药物。比较蒿甲醚和奎宁的试验没有令人信服的证据表明蒿甲醚具有死亡率优势。东南亚青蒿琥酯奎宁疟疾试验（SEAQUAMAT）是一项多中心、随机、开放标签的试验，对亚洲1461名严重疟疾成人患者进行了青蒿琥酯和奎宁的比较。青蒿琥酯组的死亡率为15%，奎宁组的死亡率为22%，青蒿琥酯组的死亡率降低了34.7%(95%可信区间：18.5-47.6%)，几乎所有的益处都报告在那些寄生虫数量高的患者身上。青蒿琥酯应成为亚洲严重疟疾的一线治疗药物。这些结果可能可以推广到所有地区成人严重疟疾的治疗，特别是对高寄生虫血症患者的治疗。然而，尚不清楚这些结果是否可以推广到非洲儿童，他们占全世界死于严重疟疾的儿童的大多数。
Quinine and the artemisinin-derivative drugs artesunate and artemether are effective treatments for severe falciparum malaria. Trials comparing artemether with quinine have not demonstrated convincing evidence of a mortality advantage for artemether. The South East Asian Quinine Artesunate Malaria Trial (SEAQUAMAT), a multicenter, randomized, open-label trial in 1461 adults with severe malaria in Asia compared artesunate with quinine. Mortality was 15% in the artesunate group and 22% in the quinine group, a reduction of 34.7% (95% confidence interval: 18.5-47.6%) in the artesunate group, with almost all the benefit reported in those with high parasite counts. Artesunate should constitute first-line treatment for severe malaria in Asia. These results can probably be generalized to the treatment of severe malaria in adults from all areas, especially in those with hyperparasitemia. However, it is unclear whether these results can be generalized to children in Africa, who constitute the majority of those who die from severe malaria worldwide.