RESUMO
BACKGROUND: In recent studies, the combination of azithromycin and artesunate has proven to be a promising alternative for the treatment of uncomplicated falciparum malaria. METHODS: We conducted a randomized, controlled clinical trial assessing the efficacy of azithromycin-artesunate combination therapy. The study was conducted involving 228 patients aged 8-65 years. Patients were randomized to 1 of 2 cohorts at a ratio of 2:1, receiving either azithromycin-artesunate once daily for 3 days (30 mg/kg per day of azithromycin plus 4 mg/kg per day of artesunate) or an adult dose of 80 mg of artemether plus 960 mg of lumefantrine (4 tablets Coartem or the equivalent for children weighing <35 kg) twice daily for 3 days. RESULTS: The 42-day cure rate by Kaplan-Meier analysis was 94.6% (95% confidence interval [CI], 89.38%-97.44%) in the azithromycin-artesunate arm and 97.0% (95% CI, 89.45%-99.40%) in the control arm. Fever clearance times and parasite clearance times did not show any differences between the 2 arms (P=.59 and .95, respectively). No serious adverse events were seen, but the percentage of patients who developed any adverse event was higher in the control group (P=.03). CONCLUSIONS: Our data suggest that azithromycin-artesunate is an efficacious and well-tolerated treatment for patients with uncomplicated falciparum malaria in Bangladesh.
Assuntos
Antimaláricos/uso terapêutico , Artemisininas/administração & dosagem , Azitromicina/administração & dosagem , Malária Falciparum/tratamento farmacológico , Adolescente , Adulto , Idoso , Animais , Antimaláricos/efeitos adversos , Artemeter , Artemisininas/efeitos adversos , Artesunato , Azitromicina/efeitos adversos , Bangladesh , Criança , Quimioterapia Combinada , Etanolaminas/administração & dosagem , Feminino , Fluorenos/administração & dosagem , Humanos , Lumefantrina , Masculino , Pessoa de Meia-Idade , Parasitemia/tratamento farmacológico , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Malaria may lead to spontaneous splenic rupture as a rare but potentially lethal complication. Most frequently, this has been reported in patients infected with Plasmodium falciparum and Plasmodium vivax, while other parasitic agents are less likely to be the cause.We report a 29-year-old British Caucasian, who after returning from a business trip in Democratic Republic Congo was diagnosed with tertian malaria caused by Plasmodium ovale.During his in-patient stay, the patient suffered a splenic rupture requiring immediate surgical intervention and splenectomy. Following this surgical intervention, there was an uneventful recovery, and the patient was discharged in a good general condition.