Artemisinin or chloroquine for blood stage Plasmodium vivax malaria in Vietnam

作者: Giao T. Phan , Peter J. de Vries , Binh Q. Tran , Hung Q. Le , Nam V. Nguyen

DOI: 10.1046/J.1365-3156.2002.00948.X

关键词: Plasmodium vivaxMalariaArtemisininClinical researchDrug resistanceVirologyRegimenChloroquineMedicineImmunologyTropical medicine

摘要: Summary Chloroquine-resistant Plasmodium vivax has not yet occurred in Vietnam. The efficacy of artemisinin forP.vivaxwasnotestablished.Weconductedadouble-blindrandomizedstudyinvolving240inpatientswithP. malaria who received (40 mg/kg over 3 days) plus placebo chloroquine (Art) orchloroquine(25 mg/kgover3 days)plusplaceboartemisinin(Chl).Patientswerefollowedupwithweeklyblood smears for 28 days. In each group 113 cases were analysed. All patients recovered rapidly. Themedian (range) parasite clearance time regimen Art was 24 h (8–72) and Chl (8–64; P ¼ 0.3).Parasitesreappearedintwocasesineachgrouponday14,ineightcasesineachgroup(7%)onday16andin 25 (23%) 18 (16%) cases, respectively, at the end 4-week follow-up (P 0.3). populationparasite curve followed a mono-exponential decline. reduction ratio per 48 hreproduction cycle 2.3 · 10 4 both regimens. We conclude that areequallyeffectiveinthetreatmentofP.vivaxinfectionsinVietnam.Reappearanceofparasitesbeforeday16(7%) suggests emergence resistance. Three days monotherapy does notprevent recrudescence.keywords vivax, artemisinin, chloroquine, Vietnam, drug-resistance, recrudescencecorrespondence P. J. de Vries, Division Infectious Diseases, Tropical Medicine AIDS, AcademicMedical Center, F4-217, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.Tel: (+)31 (0)20 5664380; Fax: 6972286; E-mail: p.j.devries@amc.uva.nlIntroductionIn South-east Asia morbidity attributable to Plasmodiumvivax prevails while falciparum gradually comes undercontrol by applying drugs with other controlmeasures such as insecticide-treated bed nets (Phan et al.1999; Nosten al. 2000). This trend also observed inBinh Thuan, mountainous province south ofVietnam (unpublished information, Binh Thuan ProvincialMalaria Station).Chloroquineisthefirst-linedrugfortreatmentofP.vivaxin most areas world (World Health Organization1997), although derivatives are used invarious regimens they appear be effective (Nguyenet 1993). It known whether chloroquine-resistantP.vivaxisprevalentinVietnam.Artemisinindrugsare very active against but beenfirmly established. Therefore, this study aimed establishand compare inthe treatment blood stage infections inVietnam. Based on our own experience pharmacody-namicmodellingofthetimecourseofP.falciparum,a3-dayregimen should effective. Longer regimenswere considered conflict good patient compliance.MethodsPatient selection treatmentFrom September 1997 January 2000, subjects aged15 years or older microscopically confirmed vivax(asexual stage) infection, presenting eight primary health

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