부산대학교 도서관

Background: Conventional treatment of imported malaria in Italy consists of quinine or mefloquine. Since β-arthemeter is now available, an open-label pharmacodynamic analysis was performed in 73 adults with uncomplicated Plasmodium falciparum malaria. In vitro susceptibility to mefloquine and quinine was evaluated at admission. Methods: According to clinical status, baseline parasitemia (P 0 ), and premunition, the patients received intravenous quinine, oral mefloquine, or β-arthemeter. The following parameters were measured: parasitemia at 0, 6, 12, and 24 hours and then every 24 hours until negative; time to 50%, 90%, and 100% reduction in parasite density (PC 50′ , PC 90′ , and PCT); parasite reduction ratio at 24 and 48 hours (PRR 24 and PRR 48 ); percentage of patients with undetectable parasitemia at 48 hours (PPUP 48 ); time required to eradication; in vitro susceptibility to mefloquine and quinine by World Health Organization Microtest Mark III. Results: Of the study patients, 54.8% were immigrants from malaria-endemic countries. All the infections were acquired in Africa. All the patients were treated successfully. According to the pharmacodynamic parameters measured, no significant differences were recorded among patients with or without prior exposure to malaria. Pharmacodynamic comparison was performed between quinine and β-arthemeter. Significantly higher clearance times were recorded for β-arthemeter vs quinine (PC 50′ PC 90′ , and PCT: 16.8, 42.6, and 72 h for quinine vs 7.9, 12.2, and 48 h for β-arthemeter; p values: .02, < .0001, and .008, respectively). The number of patients who obtained a PPUP 48 with β-arthemeter was higher than with quinine (66.7 vs 9.1%, p<.003), and PRR 24 was significantly higher in β-arthemeter-treated patients (617 vs 3.15, p = .0001). PRR 48 and time to eradication were not measurable in the β-arthemeter group (negative P at 48 h in most cases). Two recrude-scences occurred after 5 and 7 days of β-arthemeter monotherapy. All strains were fully susceptible to quinine and mefloquine. Conclusions: Pharmacodynamic properties of mefloquine and quinine are in the range reported in literature. The better PCT and pharmacodynamics of β-arthemeter suggest that it could be used as a first-line agent, coadministered with mefloquine. [ABSTRACT FROM AUTHOR]