蒿甲醚治疗恶性疟疾与磷酸哌喹的比较

本文试用蒿甲醚给30名恶性疟病人肌内注射与30名恶性疟病人口服磷酸哌喹作对照比较。蒿甲醚“五天疗法”总量480mg,磷酸哌喹“两天疗法”总量1500mg。蒿甲醚平均退热时间为21±10h,平均原虫转阴时间为76±14h,显著快于哌喹对照组。24例随访28d的复燃率为4％,和哌喹相近。蒿甲醚副反应轻,可推荐予临床作进一步研究。     

蒿甲醚片治疗恶性疟疾的临床观察

为了解蒿甲醚片治疗恶性疟疾的临床效果,最大限度地降低恶性疟疾的凶险发作及治疗过程中的不良反应,结合我国第6批赴利比里亚维和医疗分队治疗疟疾的工作实践,对蒿甲醚片治疗恶性疟疾的效果进行了临床对照观察,现报告如下.     

蒿甲醚片治疗恶性疟疾的临床观察

为了解蒿甲醚片治疗恶性疟疾的临床效果,最大限度地降低恶性疟疾的凶险发作及治疗过程中的不良反应,结合我国第6批赴利比里亚维和医疗分队治疗疟疾的工作实践,对蒿甲醚片治疗恶性疟疾的效果进行了临床对照观察,现报告如下.     

蒿甲醚`蒿琥酯及其代谢产物双氢青蒿素在血浆中的薄层扫描定量法

报道了用薄层密度扫描定量法同时测定血浆中蒿甲醚(MDA)和双氢青蒿素(DHA)(A);蒿琥酯(AS)和DHA(B)以及单独测定DHA (C)的分析方法。线性范围除B法中AS为0.1至3.5μg外,余均为0.1至4.0μg(r均大于0.99,p<0.005)。检测限A法均为0.03μg;B、C法均为0.01μg。MDA和DHA平均回收率分别为82.8和92.2％;AS和DHA分别为95.5和89.2％;DHA为96％(c.v.均在6％以内)。并进行了大鼠DHA,MDA和DHA及AS和DHA的药物动力学研究,提供了各自的参数。     

复方蒿甲醚和组份之一本芴醇两种剂型治疗恶性疟疾临床对比试验

目的 观察复方蒿甲醚及其组份之一本芴醇两种剂型治疗恶性疟疾的疗效和安全性。方法采用双盲（复方蒿甲醚组和本芴醇片剂组），随机对比的方法。病人入院后实行２８天封闭观察。结果 收治１５０例病人，其中复方蒿甲醚组（Ａ）５１例，本芴醇片剂组（Ｂ）５０例，本芴醇胶丸组（Ｃ）４９例；Ａ、Ｂ、Ｃ三组的平均退热时间分别为１７．１±８．６、３４．０±２３．２、２９．４±２４．９小时；平均原虫转阴时间分别为２９．７ ± ８．９、５１．６±１４ ．１、５４．７±１７．４小时；Ａ、Ｂ、Ｃ三组的治愈率分别为９８．２％、９２．０％、９５．８％。三组病人在观察期间均无明显不良反应发生，各项化验检查未见明显异常。结论 复方蒿甲醚和本芴醇两种剂型对恶性疟疾均有良好的治疗作用，但复方蒿甲醚在杀虫速度和控制患者症状方面明显优于本芴醇单药。     

复方青蒿治疗恶性疟疾120例

目的　观察复方青蒿 (Coartem○R,COA)治疗恶性疟疾的临床疗效。方法　对经厚滴血涂片检查证实的 12 0例恶性疟疾患者用COA 4剂法治疗。结果　COA治疗恶性疟疾起效快 ,能迅速地控制症状 ,7日治愈率为 98 3%。结论　COA治疗恶性疟疾作用迅速可靠 ,使用安全方便 ,能获得良好的临床疗效。     

坦桑尼亚重症疟疾44例治疗体会

目的探讨重症恶性疟疾的临床特点及防治。方法对44例病例的临床资料进行回顾性分析。结果38例患者体温24h内恢复正常，症状明显好转，3～4d基本治愈，5d完全治愈。3例脑疟患者经2个疗程及对症治疗痊愈。7例体温恢复正常后仍有程度不同症状。结论恶性疟疾危重病症原虫治疗是根本措施，青蒿琥酯药物治疗效果明显，及时识别和合理治疗并发症是关键。     

输入性恶性疟疾182例治疗分析

目的 探讨河南地区输入性恶性疟疾的器官功能受损程度,支持治疗方法及结果。方法 对河南省传染病医院2010年3月至2014年9月收治的182例的临床资料进行回顾性分析。结果 182例患者普通病例152例,重症病例30例。其中脑型20例、超高热型5例;厥冷型0例;高原虫症型20例;胃肠型9例;黑尿热型5例;急性肾功能衰竭型49例;肝损害型71例;休克型3例。治愈180例,死亡2例。结论 输入性恶性疟疾患者临床表现复杂,器官功能损害严重。及时临床分型识别、合理治疗对降低死亡率有重要意义。     

A comparison of oral artesunate and artemether antimalarial bioactivities in acute falciparum malaria

AIMS: Artesunate and artemether are the two most widely used artemisinin derivatives in the treatment of uncomplicated Plasmodium falciparum malaria, but there is little information on their comparative pharmacokinetics. The aim of this study was to examine the relative oral antimalarial bioavailability and pharmacokinetics of the two derivatives. METHODS: The pharmacokinetic properties of oral artesunate and artemether (4 mg kg(-1)) were compared in a randomized cross-over study of 14 adult patients in western Thailand with acute uncomplicated Plasmodium falciparum malaria. Antimalarial activity was compared using a previously validated, sensitive bioassay. RESULTS: Despite a 29% lower molar dose, oral artesunate administration resulted in significantly larger mean area under the plasma antimalarial activity time curve and median maximum plasma antimalarial activity than after oral artemether (P 相似文献   

Compliance with a 2 day course of artemether-mefloquine in an area of highly multi-drug resistant Plasmodium falciparum malaria

Aims Multi-drug resistant Plasmodium falciparum malaria is a rapidly increasing problem in the world, particularly Thailand. Practical antimalarial regimens which are highly effective against multi-drug resistant parasites with short-term course of administration are needed. In this study, we assessed the patient compliance of a short course regimen using artemether-mefloquine.
Methods Clinical effectiveness (efficacy, tolerability and patient compliance) of a 2-day regimen of artemether-mefloquine was evaluated in 126 patients with acute uncomplicated falciparum malaria who were attending the two malaria clinics in an area of highly multi-drug resistant P. falciparum malaria (Thai-Myanmar border). Patients were treated with a single oral dose of 300  mg artemether on the day of attendance. Two additional doses of mefloquine were given for home treatment on the following day (750 and 500  mg after breakfast and lunch, respectively).
Results The combination regimen was effective, with a cure rate of 92.6%. Based upon the concentrations of whole blood mefloquine on day-2, compliance for this 2 day regimen of artemether-mefloquine was 98.1% (full compliance 86.8%, partial compliance 11.3%, non-compliance 1.9%).
Conclusions We conclude that the 2 day regimen of artemether-mefloquine is, at present, a good alternative regimen for the treatment of uncomplicated multi-drug resistant falciparum malaria.     

青蒿琥酯治疗在马里共和国的恶性疟疾321例

目的 :观察青蒿琥酯对恶性疟疾的疗效。方法 :96 1例恶性疟疾病人随机分成青蒿琥酯组 32 1例 (男性 152例 ,女性 16 9例 ) ,用青蒿琥酯 6 0mg +5%葡萄糖注射液 5mL ,iv ,qd ,首剂加倍 ,疗程 5d ;奎宁 雷琐辛组 32 0例 (男性 140例 ,女性 180例 ) ,用奎宁 雷琐辛 50 0mg + 5%葡萄糖注射液 50 0mL ,iv ,gtt ,qd ,疗程 3d ;氯喹组 32 0例 (男性 143例 ,女性 177例 ) ,用氯喹 50 0mg ,po ,qd ,首剂加倍 ,疗程 3d。各组经 1个疗程治疗后未愈者 ,均继续治疗 1个疗程。结果 :治愈率青蒿琥酯组为 10 0 % ,奎宁 雷琐辛组为 97.5% ,氯喹组为 6 7.2 %。青蒿琥酯组第 2疗程和第 1疗程治愈率分别为 10 0 %和82 .6 % (P <0 .0 1) ,复燃率为 2 .8% ,无不良反应。结论 :青蒿琥酯治疗恶性疟疾安全有效     

青蒿琥酯和巴利捷克治疗塞内加尔恶性疟病儿的比较

目的：比较青蒿琥酯和巴利捷克治疗西非塞内加尔恶性疟的疗效。方法：西非恶性疟病儿１９０例，随机分为青蒿琥酯组７６例（男性４７例，女性２９例，年龄６±ｓ３ａ），用青蒿琥酯每次１５ｍｇ／ｋｇ，ｉｖ或１ｍ，于入院后即刻，ｈ４，ｈ２４，ｈ４８给药，２ｄ为一个疗程；巴利捷克组１１４例（男性６８例，女性４６例；年龄６±３ａ），用巴利捷克剂量２５ｍｇ奎宁基质／（ｋｇ·ｄ），ｉｖ或ｉｍ，ｂｉｄ，３ｄ为一个疗程。结果２组血检疟原虫转阴率，退热时间和住院时间各为９４．７％，７８．９％；１．３±０．５ｄ，２．７±１．１ｄ和３．２±１．１ｄ，４．５±１．５ｄ；差别皆有非常显著意义（Ｐ均＜０．０１）。结论：青蒿琥酯疗效优于巴利捷克。     

青蒿素哌喹片治疗无并发症恶性疟的剂量探索试验

目的探索青蒿素哌喹片治疗无并发症恶性疟的安全有效的适宜剂量。方法收治7～65岁男性和女性病人共100例,按区组随机化方案分成2组,成人总量1400 mg组年龄(22±s12)岁,1750 mg组年龄(21±12)岁。分别于0h和24h给药一次,比较2组的平均原虫转阴和退热时间、28d治愈率及原虫复燃率。结果2组的平均原虫转阴时间分别是(61±19)h和(57±21)h,平均退热时间为(20±15)h和(18±10)h,P>0.05;28 d治愈率是80%和96%,原虫复燃率为20%和4%,总量1750 mg组显著优于1400 mg组(P<0.05)。2组耐受性均良好,未发现明显的不良反应。结论推荐青蒿素哌喹片的临床治疗剂量为总量1750 mg,每日1次,分2d服完为1个疗程。     

高效液相色谱法测定蒿甲醚胶囊的含量

目的 :建立测定蒿甲醚胶囊中蒿甲醚含量的高效液相色谱法。方法 :选用ODS分析柱 ,流动相 :水 -乙腈 (45∶5 5 ) ,检测波长 :2 10nm ,流速 :1 0mL·min-1,柱温 :室温 ,外标法定量。结果 :本法简便、准确、快速。线性范围 :5 0～ 2 5 0 μg (r =0 9998)。平均回收率为 10 0 8% ,RSD =1 5 % (n =6 )。 结论 :建立的方法利于蒿甲醚胶囊的质量控制。     

青蒿琥酯和复方双氢青蒿素序贯治疗对南苏丹恶性疟疾的疗效

目的：观察注射用青蒿琥酯和复方双氢青蒿素片序贯治疗对南苏丹恶性疟疾病人的疗效。方法：回顾性分析2011年7月-2013年11月在南苏丹瓦乌中国二级医院住院的55例恶性疟疾病历。结果：肌注或静脉注射青蒿琥酯注射液（首剂120mg,后60mg/d）1~5d[（3.2±0.9）d],最后一次静脉注射或肌注后24、30、48、72h口服复方双氢青蒿素片2片,共8片。55例疟疾病人的总治愈率为100%,其中3d治愈52例（94.5%）,3~7d治愈3例（5.5%）。4例（7.3%）病人发生恶心、呕吐、腹泻或头晕等轻度不良反应。结论：注射用青蒿琥酯和复方双氢青蒿素片序贯治疗,对南苏丹恶性疟疾病人具有非常好的临床疗效,适合多种人群,耐受性好。     

Dose-finding and efficacy study for i.m. artemotil (beta-arteether) and comparison with i.m. artemether in acute uncomplicated P. falciparum malaria

AIMS: The antimalarial efficacy/pharmacodynamics and pharmacokinetics of intramuscular (i.m.) artemotil in Thai patients with acute uncomplicated falciparum malaria were studied to determine effective dose regimens and to compare these with the standard dose regimen of artemether. METHODS: In part I of the study three different artemotil dose regimens were explored in three groups of 6-9 patients for dose finding: 3.2 mg kg-1 on day 0 and 1.6 mg kg-1 on days 1-4 (treatment A), 1.6 mg kg-1 on day 0 and 0.8 mg kg-1 on days 1-4 (treatment B), 3.2 mg kg-1 on day 0 and 0.8 mg kg-1 on days 1-4 (treatment C). In part II of the study, artemotil treatments A and C were compared in three groups of 20-22 patients with standard i.m. artemether treatment: 3.2 mg kg-1 on day 0 and 0.8 mg kg-1 on days 1-4 (treatment R). RESULTS: Full parasite clearance was achieved in all patients in Part I, but parasite clearance time (PCT) and fever clearance time (FCT) tended to be longer in treatment B. Also the incidence of recrudescence before day 28 (RI) tended to be higher for treatment B. In part II, the mean PCT for each of the two artemotil treatments (52 and 55 h, respectively) was significantly longer than for artemether (43 h). The 95% CI for the difference A vs R was 0, 16 h (P=0.0408) and for difference C vs R it was 2, 19 h (P=0.0140). FCT was similar for the three treatments. The incidence of RI ranged from 5 out of 19 for treatment C to 3 out of 20 for treatment R. Plasma concentration-time profiles of artemotil indicated an irregular and variable rate of absorption after i.m. injection. A late onset of parasite clearance was associated with delayed absorption and/or very low initial artemotil plasma concentrations. Pharmacokinetic-pharmacodynamic evaluations supported a relationship between the rate of parasite clearance and exposure to artemotil during approximately the first 2 days of treatment, and suggested that artemotil has a slower rate of absorption than artemether. Safety assessment, including neurological and audiometric examinations showed no clinically relevant findings. Adverse events before and during treatment included headache, dizziness, nausea, vomiting and abdominal pain. These are characteristic of acute malaria infections and resolved during treatment. CONCLUSIONS: The optimum dose regimen for artemotil in this study was identical to the standard dose regimen of artemether. The findings that artemotil is more slowly absorbed from the i.m. injection site than artemether, and that early systemic availability may be insufficient for an immediate onset of parasite clearance contributed to the decision to choose a higher loading dose of artemotil (divided over two injection sites) and to omit the fifth dose in later studies. With this optimized dosing schedule, the more pronounced depot characteristics of i.m. artemotil can be an advantage, since it may allow shorter hospitalization.