RESUMEN
OBJECTIVE: Thiamin deficiency complicates severe Plasmodium falciparum malaria in Thailand and may contribute to acidosis. We therefore estimated the frequency of biochemical thiamin deficiency in patients presenting with uncomplicated falciparum malaria in southern Laos. METHODS: Red cell transketolase activation coefficients (alpha) were measured in 310 patients presenting with uncomplicated falciparum malaria and 42 days after starting treatment. RESULTS: Twelve per cent of patients had biochemical evidence of severe deficiency (alpha values >1.31) at presentation, declining to 3% 42 days later. CONCLUSION: Thiamin deficiency was common in Lao patients admitted with uncomplicated P. falciparum infection and was reduced following treatment of malaria and multivitamin supplementation. The role of this preventable and treatable disorder in malaria and other acute infections, and the incidence of beriberi in rural Laos, needs further investigation.
Asunto(s)
Malaria Falciparum/epidemiología , Deficiencia de Tiamina/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antimaláricos/uso terapéutico , Artemisininas/uso terapéutico , Artesunato , Beriberi/complicaciones , Beriberi/epidemiología , Niño , Preescolar , Cloroquina/uso terapéutico , Combinación de Medicamentos , Quimioterapia Combinada , Activación Enzimática , Eritrocitos/enzimología , Femenino , Humanos , Lactante , Laos/epidemiología , Malaria Falciparum/complicaciones , Malaria Falciparum/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pirimetamina/uso terapéutico , Sesquiterpenos/uso terapéutico , Sulfadoxina/uso terapéutico , Deficiencia de Tiamina/complicaciones , Transcetolasa/metabolismo , Resultado del TratamientoRESUMEN
The efficacy of the six-dose regimen of artemether-lumefantrine was compared with the combination of artesunate and mefloquine in a randomised, comparative trial in Luang Namtha Province, Northern Laos. Of 1033 screened patients, 201 were positive for Plasmodium falciparum; 108 patients of all age groups (2-66 years) with acute, uncomplicated P. falciparum malaria were enrolled in the study, 100 of whom were followed-up for 42 days. Fifty-three patients received artemether-lumefantrine and 55 received artesunante-mefloquine. Both drug combinations induced rapid clearance of parasites and malaria symptoms; there was no significant difference in the initial therapeutic response parameters. Both regimes were well tolerated. After 42 days, cure rates were 93.6% (95% CI = 82.5-98.7%; 44 of 47 patients) for artemether-lumefantrine and 100% (95% CI = 93.3-100.0%; 53 of 53 patients) for artesunate-mefloquine. The results show the excellent efficacy and tolerability of both artemether-lumefantrine and artesunate-mefloquine in Northern Laos.
Asunto(s)
Antimaláricos/uso terapéutico , Artemisininas/uso terapéutico , Etanolaminas/uso terapéutico , Fluorenos/uso terapéutico , Malaria Falciparum/tratamiento farmacológico , Mefloquina/uso terapéutico , Sesquiterpenos/uso terapéutico , Enfermedad Aguda , Adolescente , Adulto , Anciano , Antimaláricos/efectos adversos , Arteméter , Artemisininas/efectos adversos , Artesunato , Disponibilidad Biológica , Niño , Preescolar , Quimioterapia Combinada , Etanolaminas/efectos adversos , Etanolaminas/farmacocinética , Femenino , Fluorenos/efectos adversos , Fluorenos/farmacocinética , Humanos , Corea (Geográfico)/epidemiología , Lumefantrina , Malaria Falciparum/epidemiología , Masculino , Mefloquina/efectos adversos , Persona de Mediana Edad , Parasitemia/tratamiento farmacológico , Parasitemia/epidemiología , Sesquiterpenos/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Recent clinical trials in the Lao People's Democratic Republic have demonstrated that chloroquine and sulfadoxine-pyrimethamine, which are national malaria treatment policy, are no longer effective in the treatment of uncomplicated Plasmodium falciparum malaria. METHODS: A randomized comparison of 3 oral antimalarial combinations--chloroquine plus sulfadoxine-pyrimethamine versus artesunate plus mefloquine versus artemether-lumefantrine--with 42-day follow-up period, was conducted among 330 patients with acute uncomplicated falciparum malaria in southern Laos. RESULTS: The 42-day cure rates, as determined by intention-to-treat analysis and adjusted for reinfection, were 100%, 97%, and 93% for the groups receiving artesunate plus mefloquine, artemether-lumefantrine, and chloroquine plus sulfadoxine-pyrimethamine, respectively. Of 8 patients receiving chloroquine plus sulfadoxine-pyrimethamine who experienced treatment failure, 6 had early treatment failure. The mean parasite clearance time was significantly longer in patients treated with chloroquine plus sulfadoxine-pyrimethamine (2.9 days; 95% confidence interval [CI], 2.8-3.0 days) than in those treated with artesunate plus mefloquine (2.07 days; 95% CI, 2.0-2.1 days; P<.001) and artemether-lumefantrine (2.08 days; 95% CI, 2.0-2.1 days; P<.001). Cure rates with artemether-lumefantrine were high despite low mean daily dietary fat intake (13.8 g; 95% CI, 12.5-15.1 g) and day 7 plasma lumefantrine concentrations (0.47 mu g/mL; 95% CI, 0.38-0.56 mu g/mL). CONCLUSION: Oral artesunate plus mefloquine and artemether-lumefantrine are highly effective for the treatment of uncomplicated falciparum malaria in Laos.