ORAL ARTESUNATE IN THE TREATMENT OF UNCOMPLICATED HYPERPARASITEMIC FALCIPARUM-MALARIA
ORAL ARTESUNATE IN THE TREATMENT OF UNCOMPLICATED HYPERPARASITEMIC FALCIPARUM-MALARIA
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DOI：
10.4269/ajtmh.1995.53.522
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发表时间：
1995-11-01
影响因子：
3.3
通讯作者：
WHITE, NJ
中科院分区：
文献类型：
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作者：
LUXEMBURGER, C;NOSTEN, F;WHITE, NJ
患有无并发症的高寄生虫血症恶性疟疾的患者通常给予胃肠外抗疟治疗，以防止重要器官功能障碍和死亡的进展。由于口服青蒿素衍生物比其他抗疟药物起效更快，我们将口服青蒿琥酯（4 mg/kg/天，持续3天，第二天甲氟喹25 mg/kg），静脉注射奎宁负荷剂量（最初20 mg盐/kg，然后每8小时10 mg/kg，其次是甲氟喹25毫克/公斤）在一项开放配对随机试验中的60例急性恶性疟疾和大于4%的寄生虫血症，但没有证据的重要器官功能障碍。没有死亡病例，也没有患者发展为严重疟疾。口服青蒿琥酯治疗导致发热消退的中位[范围]时间缩短（19小时[4-45] vs 47小时[4-107]）（P < 0.0001），寄生虫清除率（36小时[18-61]对82小时[36-140]）（P < 0.0001），出院（25小时[12-44]对58小时[24-115]）（P < 0.0001）。青蒿琥酯无毒性反应。青蒿琥酯组和奎宁组第28天的治愈率分别为70%（19/27）和39%（11/27）（相对危险度= 1.7; 95%置信区间= 1.0-3.0）。口服青蒿琥酯治疗无并发症的寄生虫血症比静脉注射奎宁更简单、更便宜、更安全、更有效。
Patients with uncomplicated hyperparasitemic falciparum malaria are usually given parenteral antimalarial treatment to prevent a progression to vital organ dysfunction and death. Since the oral artemisinin derivatives are more rapidly effective than other antimalarial drugs, we compared oral artesunate (4 mg/kg/day for three days with mefloquine 25 mg/kg on the second day) with an intravenous quinine loading dose (20 mg of salt/kg initially then 10 mg/kg every 8 hr, followed by mefloquine 25 mg/kg) in an open paired randomized trial in 60 patients with acute falciparum malaria and greater than 4% parasitemia, but no evidence of vital organ dysfunction. There were no deaths and none of the patients progressed to develop severe malaria. Oral artesunate treatment resulted in shorter median [range] times to fever clearance (19 hr [4-45] versus 47 hr [4-107]) (P < 0.0001), parasite clearance (36 hr [18-61] versus 82 hr [36-140]) (P < 0.0001), and discharge from the hospital (25 hr [12-44] versus 58 hr [24-115]) (P < 0.0001). There was no toxicity attributable to artesunate. The cure rates by day 28 were 70% (19 of 27) and 39% (11 of 27) in the artesunate and quinine groups, respectively (relative risk = 1.7; 95% confidence interval = 1.0-3.0). Oral artesunate was simpler, cheaper, safer, and more effective than intravenous quinine for the treatment of uncomplicated hyperparasitemia.