ABSTRACT
O quinino foi o primeiro medicamento correntemente usado para tratar malária, tendo sido abandonado seu emprego principalmente após o início do emprego da cloroquina. A partir da década de 60 com o surgimento de resistência do P. falciparum à cloroquina voltou-se a utilizar o quinino isolado ou em associação para tratar tal infecção. Com o objetivo de avaliar clinicamente a resposta ao quinino de pacientes com malária por P. falciparum, analisamos os prontuários de 484 pacientes atendidos no Laboratório de Malária da SUCEN e acompanhados por pelo menos 28 dias, e que haviam recebido diferentes esquemas terapêuticos com quinino isolado ou em associação. Do total, 81,0% dos pacientes foram curados pelos esquemas empregados, sendo que dos restantes apenas 0,6% foram R2 e nenhum R3. Tais resultados mostram ainda que esquemas contendo quinino podem ser adequados para tratar malária por P. falciparum.
Quinine was the first antimalarial drug to be employed and also the first resistance was noticed to. After 1960 quinine urged to be reintroduced in routine therapy alone or in combination. Aiming at evaluating the effectiveness of different schedules we studied 484 patients seen at the Malaria Laboratory. We used quinine alone in 126 patients, quinine plus sulfadoxine and pyrimethamine in 119 patients and quinine plus tetracycline in 239 patients. The results shown that 81% of all patients were treated with success and only 0.6% were R2. and there is no R3. We emphasize a high resistance rate to quinine either alone (23.1%) or associated to sulfadoxine and pyrimethamine (37.8%). A higher resistance rate seen with the combination might be linked to the smaller dose of quinine used in that instance. It is worth noting the high cure rate with the quinine-tetracycline association.
Subject(s)
Adult , Humans , Antimalarials/administration & dosage , Malaria, Falciparum/drug therapy , Quinine/administration & dosage , Antimalarials/antagonists & inhibitors , Drug Evaluation , Time Factors , Remission Induction , Pyrimethamine/administration & dosage , Drug Therapy, Combination , Quinine/antagonists & inhibitors , Drug Resistance , Sulfadoxine/administration & dosage , Tetracycline/administration & dosageABSTRACT
We evaluated the temporal progression of in vitro P. falciparum resistance to chloroquine, amodiaquine, quinine and mefloquine in two areas with distinct socioeconomical and geographical characteristics: Lourenço, in Amapá state and Paragominas, in Pará state. The former region is essentially an ®open® gold mining camp, whereas the latter is one currently undergoing a colonization settlement process, in addition to expanding economical activities which mainly include cattle raising and wood exploitation. Our results show high resistance rates to chloroquine in the two study areas: 79.8 per cent and 68.4 per cent in Lourenço and Paragominas, respectively. Variations in the response of P. falciparum to both amodiaquine and quinine were recorded throughout the study period. On the other hand, no mefloquine P. falciparum resistant strains could be identified, despite the tact we had noted a decrease in sensitivity to this antimalarial drug throughout the study period.
Subject(s)
Humans , Animals , Male , Female , Adolescent , Adult , Middle Aged , Antimalarials/antagonists & inhibitors , Plasmodium falciparum/drug effects , Brazil , Geography , Malaria, Falciparum/parasitology , Plasmodium falciparum/isolation & purification , Drug Resistance , Socioeconomic Factors , Time FactorsABSTRACT
Este estudo avalia a evoluçäo da sensibilidade in vitro do Plasmodium falciparum em uma área de prospecçäo de ouro no Estado do Amapá no período de 1983 a 1990. Foram efetuados 75 testes para cloroquina e quinino, 74 para amodiaquina e 76 para nefloquina. Os resultados revelaram 81 por cento de resistência à cloroquina e 27 por cento para a amodiaquina, enquanto que para quinino e mefloquina näo foram evidenciadas cepas resistentes. Contudo, para estas duas últimas drogas identificou-se uma crescente perda da sensibilidade ao longo do tempo. Aparentemente observa-se uma associaçäo entre resistência à cloroquina e a diminuiçäo da sensibilidade ao quinino