Artesunate versus artemether for the treatment of recrudescent multidrug-resistant falciparum malaria
Artesunate versus artemether for the treatment of recrudescent multidrug-resistant falciparum malaria
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DOI：
10.4269/ajtmh.1998.59.883
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发表时间：
1998-12-01
影响因子：
3.3
通讯作者：
White, N
中科院分区：
文献类型：
--
作者：
Price, R;Van Vugt, M;White, N
在泰国西部边境443例患者中进行了一项开放随机试验，比较了青蒿琥酯（2mg/kg/天，连续5天，然后1mg /kg/天，连续2天：总= 12mg /kg）与蒿甲醚（4mg /kg，然后2mg/kg/天，连续2天，然后1mg /kg/天，连续4天：总= 12mg /kg）治疗复发性耐多药恶性疟疾的疗效和毒性。两组的寄生虫和发热清除时间相似；48小时内，94%（95%可信区间[CI] = 91 ~ 96%]）的患者出现了吸虫病，93% （95% CI = 89 ~ 96%）的患者出现了发热。青蒿琥酯组症状缓解和肝肿大消退稍慢；校正后的危险比分别为1.5 （95% CI = 1 ~ 2.0, P < 0.01）和2.2 （95% CI = 1.4 ~ 8, P = 0.04）。治疗组间贫血或脾肿大消退或发展的时间无显著差异。到第28天，3% （95% CI = 0.3-5%）的用青蒿琥酯治疗的患者和6% （95% CI = 2-9%）的用蒿甲醚治疗的患者复发感染（P = 0.3）。两种方案的耐受性都很好，没有明显的副作用可归因于任何衍生物。总体而言，这些数据表明，这两种口服青蒿素衍生物是安全、高效的，并且在治疗耐药恶性疟疾方面产生相同的治疗反应。
The therapeutic efficacy and toxicity of artesunate (2mg/kg/day for five days, then 1 mg/kg/day for two days: total = 12 mg/kg) was compared with that of artemether (4 mg/kg followed by 2 mg/kg/day for two days, then 1 mg/kg/day for four days: total = 12 mg/kg) for the treatment of recrudescent multidrug-resistant falciparum malaria in an open randomized trial in 443 patients living on the western border of Thailand. Parasite and fever clearance times were similar in both groups; within 48 hr 94% (95% confidence interval [CI] = 91-96%]) of the treated patients were aparasitemic and 93% (95% CI = 89-96%) were afebrile. Symptom resolution and resolution of hepatomegaly were slightly slower in the artesunate group; adjusted hazards ratio = 1.5 (95% CI = 1-2.0, P < 0.01) and 2.2 (95% CI = 1.4-8, P = 0.04), respectively. There was no significant difference in times to resolution or development of anemia or splenomegaly between treatment groups. By day 28, 3% (95% CI = 0.3-5%) of the patients treated with artesunate and 6% of those treated with artemether (95% CI = 2-9%) had recurrent infections (P = 0.3). Both regimens were very well tolerated, with no significant adverse effects attributable to either derivative. Overall, these data suggest that the two oral artemisinin derivatives are safe, highly effective, and result in equivalent therapeutic responses in the treatment of drug-resistant falciparum malaria.