Artesunate versus artemether for the treatment of recrudescent multidrug-resistant falciparum malaria

被引:55
作者
Price, R
Van Vugt, M
Nosten, F
Luxemburger, C
Brockman, A
Phaipun, L
Chongsuphajaisiddhi, T
White, N
机构
[1] Mahidol Univ, Fac Trop Med, Bangkok 10400, Thailand
[2] Shoklo Malaria Res Unit, Mae Sot 63110, Tak, Thailand
[3] St George Hosp, Sch Med, Div Infect Dis, London, England
[4] Univ Amsterdam, Acad Med Ctr, Div Infect Dis Trop Med & AIDS, Amsterdam, Netherlands
[5] John Radcliffe Hosp, Nuffield Dept Clin Med, Ctr Trop Med, Oxford OX3 9DU, England
基金
英国惠康基金;
关键词
D O I
10.4269/ajtmh.1998.59.883
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
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.
引用
收藏
页码:883 / 888
页数:6
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