BMC ：抗疟药栓剂为患者“争取时间”
栓剂可以为疟疾患者提供快速起效的治疗。（Wikicommons/Alcibiades）
科学家说，一种一次性的抗疟药直肠栓剂可以为患有恶性疟疾的患者争取至关重要的时间。这些患者可能无法容易地获得医疗。他们的研究发表在了3月28日出版的《生物医学中心·传染病》（BioMedCentral Infectious Diseases ）杂志上。
目前世界卫生组织的指导方针包括了在转诊前使用栓剂治疗疟疾。但是三种抗疟药——青蒿素、青蒿琥酯和蒿甲醚——栓剂的有效性从未进行过比较。
这组科学家从共有1167名患者参与的15个抗疟药栓剂临床试验中汇集了数据。
这些试验对各种栓剂在12和24小时后从患者血液中清除恶性疟原虫（Plasmodium falciparum）的能力进行了评估。24小时后疟原虫减少90%被认为是成功。
这组科学家还测试了使用一剂和多剂栓剂哪个更有效。他们也测试了必须的总剂量以及栓剂的安全性。他们发现青蒿素和青蒿琥酯是安全的，而且可以迅速清除疟原虫，它们的剂量越高效果越好。蒿甲醚缺乏用于得出可靠结论的信息。
最初的高剂量是治疗成功的关键。该论文的作者之一、世界卫生组织在瑞士的热带病研究和培训特别项目的研究员Melba Gomes说：“重要的是获得足够的抗疟药活性浓度，从而迅速减少疟原虫，因为每一小时都非常关键。”
她说：“最初的高剂量在24小时内足以降低疟原虫数量，而且事实上它比在头24小时内连续使用低剂量的同样的药物更方便。”
她说：“关键在于，如果你尽早用药——而这些患者确实需要注射药物，但是在数小时内无法接受注射——那么这可能为你争取到一些时间，让你的孩子活着到达医院。”
英国伦敦卫生学和热带医学院临床研究组的Ron Behrens说：“该研究表明可以在早期提供有效而安全的疟疾疗法，它既可以由医务工作者提供，甚至也可以由母亲提供，而且可能导致疟疾死亡的减少。”
他还说：“这为世界卫生组织和国家疟疾控制项目对这类干预措施进行战略规划开了绿灯。”但是他也承认，供应这些药物的问题和成本仍然有待解决。（来源：科学与发展网络 Katherine Nightingale）
生物谷推荐原始出处：
BMC Infectious Diseases 2008,8:39 doi:10.1186/1471-2334-8-39
Rectal artemisinins for malaria:a review of efficacy and safety from individual patient data in clinical studies
Melba Gomes Isabela Ribeiro Marian Warsame Harin Karunajeewa Max Petzold
Abstract
Background
Rectal administration of artemisinin derivatives has potential for early treatment for severe malaria in remote settings where injectable antimalarial therapy may not be feasible.Preparations available include artesunate,artemisinin,artemether and dihydroartemisinin.However each may have different pharmacokinetic properties and more information is needed to determine optimal dose and comparative efficacy with each another and with conventional parenteral treatments for severe malaria.
Methods
Individual patient data from 1167 patients in 15 clinical trials of rectal artemisinin derivative therapy(artesunate,artemisinin and artemether)were pooled in order to compare the rapidity of clearance of Plasmodium falciparum parasitaemia and the incidence of reported adverse events with each treatment.Data from patients who received comparator treatment(parenteral artemisinin derivative or quinine)were also included.Primary endpoints included percentage reductions in parasitaemia at 12 and 24 hours.A parasite reduction of>90%at 24 hours was defined as parasitological success.
Results
Artemisinin and artesunate treatment cleared parasites more rapidly than parenteral quinine during the first 24 hours of treatment.A single higher dose of rectal artesunate treatment was five times more likely to achieve>90%parasite reductions at 24 hours than were multiple lower doses of rectal artesunate,or a single lower dose administration of rectal artemether.
Conclusions
Artemisinin and artesunate suppositories rapidly eliminate parasites and appear to be safe.There are less data on artemether and dihydroartemisinin suppositories.Themore rapid parasite clearance of single high-dose regimens suggests that achieving immediate high drug concentrations may be the optimal strategy.
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