We performed an open, randomized chemotherapy trial comparing the recommended first-, second- and third-line drug regimens, as well as mefloquine, for uncomplicated falciparum malaria in Bangladesh in 1996-97. The regimens were chloroquine for 3 days (CQ, Group I), quinine sulphate for 3 days followed by single-dose sulfadoxine-pyrimethamine (Q3 + SP, Group II), quinine for 7 days (Q7, Group III), and mefloquine 20 mg/kg single dose (MEF, Group IV). Subjects were symptomatic patients, aged > or = 12 years, with parasite density 500-250,000/mm3 and no history of taking antimalarials during the previous week. Drug administration was supervised and subjects were followed clinically and with blood slides in the hospital for 8 days, then as outpatients on days 14, 21 and 28. A total of 413 subjects (149, 145, 49 and 70 in Groups I-IV, respectively) completed the study. Early treatment failures (persistent or worsening clinical manifestations by day 3 confirmed with parasitological examinations) occurred only in the chloroquine group. RII and RIII parasitological failures occurred in 56%, 12%, 8% and 14% in Group I-IV, respectively. There were significantly more clinical and parasitological failures with chloroquine than with Q3 + SP, which we now recommend as a better (but far from ideal) choice for first-line therapy. The alternative compounds show parasitogical evidence of Plasmodium falciparum resistance. Further studies are needed to determine the optimum treatment for malaria in Bangladesh.

译文

我们进行了一项开放的随机化学疗法试验,比较了1996-97年孟加拉国推荐的一线,二线和三线药物方案以及甲氟喹治疗单纯性恶性疟疾。方案为氯喹3天 (CQ,I组),硫酸奎宁3天,然后单剂量磺胺多辛-乙胺嘧啶 (Q3 SP,II组),奎宁7天 (Q7,III组) 和甲氟喹20 mg/kg单剂量 (MEF,第四组)。受试者为症状患者,年龄> 或 = 12岁,寄生虫密度为500-250,000/mm3,前一周无服用抗疟药史。监督药物管理,对受试者进行临床随访,并在医院用玻片进行8天,然后在第14、21和28天作为门诊患者。共有413名受试者 (i-iv组分别为149、145、49和70名) 完成了研究。早期治疗失败 (经寄生虫学检查证实的第3天持续或恶化的临床表现) 仅发生在氯喹组中。RII和RIII寄生虫学失败分别发生在i-iv组的56%,12%,8% 和14% 中。与Q3 SP相比,氯喹的临床和寄生虫学失败明显更多,我们现在建议将其作为一线治疗的更好 (但远非理想) 选择。替代化合物显示出恶性疟原虫抗性的寄生虫证据。需要进一步研究以确定孟加拉国疟疾的最佳治疗方法。

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