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Quimioprofilaxia da malária com mefloquina na amazônia brasileira

Resumos

Em estudo randômico dupb-cego, 122 voluntários morando em área endêmica de malária na Região Amazônica (Estado de Rondônia) foram divididos em quatro grupos para estudo da supressão malárica. O grupo 1 recebeu 500mg de mefloquina a cada quatro semanas; o grupo II 250mg de mefloquina a cada duas semanas; o grupo III um comprimido de Fansidar (500mg de sulfadoxina + 25mg de pirimetamina) por semana e o grupo IV, recebeu apenas placebo. Um ataque agudo de malária ocorreu em um indivíduo do grupo 1, em dois indivíduos do grupo II e em seis indivíduos dos grupos III e IV. A proteção verificada nos grupos em uso de mefloquina foi significantemente superior comparada ao grupo placebo. A mefloquina, em ambas as dosagens usadas, mostrou-se efetiva na supressão malárica em uma área onde o Plasmodium falciparum plurirresistente é altamente prevalente.

Malária; Mefloquina; Quimioprofilaxia


In a randomised double blind study 122 volunteers living in an endemic malarious area in Amazonian Rondonia State were divided into 4 groups to study malaria supression. The first group received 500mg of mefloquine every month, group II 250mg every two weeks, group III a tablet of Fansidar (500mg sulphadoxine + 25mg pyrimethamine) a week and group IVplacebo. Acute attacks of malaria occured in one individual in group I, 2 subject in group II, and 6 individuals in groups 111 e IV. Protection with mefloquine was significant compared with the placebo group. Both treatment regimens with mefloquine were effective supressants in an area of high prevalence of drug multiresistant Plasmodium falciparum transmission.

Malaria; Mefloquine; Chemoprophylaxis


ARTIGOS

Quimioprofilaxia da malária com mefloquina na amazônia brasileira

João Barberino Santos; Aluízio Prata; Eduardo Wanssa

Endereço para correspondência Endereço para correspondência: Dr. João Barberino Santos. Centro de Pesquisa e Tratamento de Malária do Vale do Guaporé. Av. Limoeiro s/n. 78971-000 Costa Marques, RO.

RESUMO

Em estudo randômico dupb-cego, 122 voluntários morando em área endêmica de malária na Região Amazônica (Estado de Rondônia) foram divididos em quatro grupos para estudo da supressão malárica. O grupo 1 recebeu 500mg de mefloquina a cada quatro semanas; o grupo II 250mg de mefloquina a cada duas semanas; o grupo III um comprimido de Fansidar (500mg de sulfadoxina + 25mg de pirimetamina) por semana e o grupo IV, recebeu apenas placebo. Um ataque agudo de malária ocorreu em um indivíduo do grupo 1, em dois indivíduos do grupo II e em seis indivíduos dos grupos III e IV. A proteção verificada nos grupos em uso de mefloquina foi significantemente superior comparada ao grupo placebo. A mefloquina, em ambas as dosagens usadas, mostrou-se efetiva na supressão malárica em uma área onde o Plasmodium falciparum plurirresistente é altamente prevalente.

Palavras-chave: Malária. Mefloquina. Quimioprofilaxia.

ABSTRACT

In a randomised double blind study 122 volunteers living in an endemic malarious area in Amazonian Rondonia State were divided into 4 groups to study malaria supression. The first group received 500mg of mefloquine every month, group II 250mg every two weeks, group III a tablet of Fansidar (500mg sulphadoxine + 25mg pyrimethamine) a week and group IVplacebo. Acute attacks of malaria occured in one individual in group I, 2 subject in group II, and 6 individuals in groups 111 e IV. Protection with mefloquine was significant compared with the placebo group. Both treatment regimens with mefloquine were effective supressants in an area of high prevalence of drug multiresistant Plasmodium falciparum transmission.

Keywords: Malaria. Mefloquine. Chemoprophylaxis.

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REFERÊNCIAS BIBLIOGRÁFICAS

1. Alecrim MGC. Estudo da resistência do Plasmodium falciparum às drogas anti-maláricas in vivo e in vitro na Amazônia. Tese de Mestrado em Medicina Tropical. Universidade de Brasília, Brasília, 1981.

2. Bjo rkman A, Phillips-Howard PA. The epidemiology ofdrug-resistant malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene 84:177- 180, 1990.

3. Brasseur P, Konamano J, Moyon RS, Druilhe P. Emmergence of mefloquine-resistant malaria in África without drug pressure. The Lancet 336:59, 1990.

4. Brecknridge A. Risks and benefits of prophylactic antimalarial drugs.British Medical Journal299:1057- 1058, 1989.

5. Chippaux JP, Massougbodji A, Akogbeto M, Josse R, Zohoun T, Sadeler BC. Evolution de la chimiosensibilité de Plasmodium falciparum a la chloroquine et a la méfloquine au Bénin entre 1980 et 1989. Bulletin de la Societé de Pathologie Exotique 83:320-329, 1990.

6. Clyde DF, Mc Carthy VC, Miller RM, Hornick RB. Supressive activity of mefloquine in sporozoite- induced human malaria. Antimicrobial Agents and Chemotherapy 9:384-386, 1976.

7. De Souza JM. Mefloquine clinical trials - Therapeutical experience with mefloquine alone and in combination (MSP) in brazilian male subject with falciparum malaria. Memórias do Instituto Oswaldo Cruz 81(supl Il):259-268, 1986.

8. De Souza JM, Heizmann P, Schwartz DE. Single- dose kineticsof mefloquine in Brazilian male subjects. Bulletin of the World Health Organization 65:353- 356, 1987.

9. Doberstin EB, Phintuyothin P, Noeypatimanondh S, Teerakiartjamjom C. Single-dose therapy of falciparum malaria with mefloquine or pyrimethamine-sulfadoxine. Bulletin of the World Health Organization 57:275-278, 1979.

10. Felix R, Gay F, Lyogoubi A, Bustos MDG, Diquet B, Davis M, Gentilini M. Résistance croiseé a la mefloquine et a l'halofantrine lors d'un paludismea Plasmodium falciparum contracté en Sierra Leone. Bulletin de la Societé de Pathologie Exotique 83:43- 45, 1990.

11. Felix H, Gentilin M. La mefloquine-Rapport preliminaire. In: Resums de le Deuxiéme Congrés de la Societé Mediterranéenne de Chimiotherapie, Nice, France, 1980.

12. Gay F, BinetMH, Bustos MDG, RrouveixB, Danis M, Roy C, Gentilini M. Mefloquine failure in child contracting falciparum malaria in west Africa. The Lancet 355:120-121, 1990.

13. Gilles HM. The treatment and prophy laxis of malaria. Annals of Tropical Medicine and Parasitology 81:607-617, 1987.

14. Greenwood BM. The impact of malaria chemoprophy laxis on the immune status of Africans. Bulletin of the World Health Organization 62(suppl):69-75, 1984.

15. Karwacki JJ, WebsterHK, Limsonwong N, Shanks GD. Two cases of mefloquine resistant malaria in Thailand. Transactions of the Royal Society of Tropical Medicine and Hygiene 83:152-153, 1989.

16. Kiliami VAEB, Mkufya AR, Kilama WL. Low resistance of Plasmodium falciparum to mefloquine in Tanga region Tanzania. Transactions of the Royal Society of Tropical Medicine and Hygiene 83:162- 164, 1989.

17. Kremsner PG, Zotter GM, Feldmeier H, Bienzle V, Jansea-Rosseck R, Graninger W, Rocha M, Wernsdorfer WH. Differences in drug response of Plasmodium falciparum within an area of the Amazon Region. Transactions of the Royal Society of Tropical Medicine and Hygiene 83:158-161, 1989.

18. Maynaidé M, Peceno C, Noriega P-L, Yarzabal L. Susceptibility of Plasmodium falciparum strains to chloroquine and mefloquine in the Amazonas Federal Territory of Venezuela. Transactions of the Royal Society of Tropical Medicine and Hygiene 83:586- 588, 1989.

19. Nosten F, Terkuile F, Chongsuphajaisiddhi T, Luxemburger C, Webster HK, Edstein M, Phaipun L, Kyan LT, White NJ. Mefloquine-resistant falciparum malaria on the Thai-Bumeseborder. The Lancet 337:1140-1143, 1991.

20. PetersW,PortusJ, RobinsonBL. The chemotherapy of rodent malaria. XXVIII, The development of resistance to mefloquine (WR 142,190). Annals of Tropical Medicine and Parasitology 71:419-426, 1977.

21. Petersen E, Hogh B, Bygbjerg IC, Black FT. Malaria chemopropylaxis: Why mefloquine? The Lancet 336:811, 1990.

22. Peto TEA, Gilks CF. Strategies for the prevention of malaria in travellers: comparison ofdrug regimens by means of risk-benefit analy sis. The Lancet 1:1256- 1261, 1986.

23. Phillips-Howard PA, Bjorkman AB. Ascertainment of risk of serious adverse reactions associated with chemoprophylatic antimalarial drugs. Bulletinof the World Health Organization 68:493-504, 1990.

24. Pinotti M, Soares R. A erradicação da malária com sal cloroquinado. Revista Brasileira de Malariologia e Doenças Tropicais 8:253-265, 1956.

25. Ponnapaham JT. Mefloquine in the treatment of malaria a preliminary study. Abstract of the lOth Congress of Tropical Medicine and Malaria. Manila, Philippines p.9-15, 1980.

26. Prata A, Santos JB, Ferreiral, Leimer R. Supressive treatment of malaria in the Amazon Region. In: Abstracts of the XI International Congress of Tropical Medicine and Malaria. Calgary (Canadá) p. 122, 1984.

27. Reyes S, Osanai CH, Passos ADC. Resistência in vivo do Plasmodium falciparum às 4-amino- quino leinas e à associação sulfado xina-pirimetamina. II - Estudo de Manaus, Amazonas 1983-1984. Revista Brasileira de Malariologia e Doenças Tropicais 38:37-44, 1986.

28. Santos JB, Prata A. Tratamento de 75 pacientes portadores de malária pelo P. falciparum em Porto Velho (RO), com mefloquina. Revista da Sociedade Brasileira de Medicina Tropical 21:181-185,1988.

29. Sturchler D. Malaria prophylaxis in travellers: the current position. Experientia 40:1357-1362, 1984.

30. Sturchler D, Handschin J, Kaiser D, Kerr L, Mittelholzer ML, Reber R, Fernex M. Neuropsychiatric side effects of mefloquine. The New England Journal of Medicine 333:1752-1753, 1990.

31. Wemsdorfer WH. Current approaches to malaria chemotherapy and prophylaxis. Parasitology Today 2:220-253, 1986. 32. World Health Organization. Advances in malaria chemotherapy. Technical Repports Series no 711, Geneva, 1984.

Recebido para publicação em 15/05/91.

Núcleo de Medicina Tropical e Nutrição da Universidade de Brasília, Brasília, DF.

  • 1. Alecrim MGC. Estudo da resistência do Plasmodium falciparum às drogas anti-maláricas in vivo e in vitro na Amazônia. Tese de Mestrado em Medicina Tropical. Universidade de Brasília, Brasília, 1981.
  • 2. Bjo rkman A, Phillips-Howard PA. The epidemiology ofdrug-resistant malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene 84:177- 180, 1990.
  • 3. Brasseur P, Konamano J, Moyon RS, Druilhe P. Emmergence of mefloquine-resistant malaria in África without drug pressure. The Lancet 336:59, 1990.
  • 4. Brecknridge A. Risks and benefits of prophylactic antimalarial drugs.British Medical Journal299:1057- 1058, 1989.
  • 5. Chippaux JP, Massougbodji A, Akogbeto M, Josse R, Zohoun T, Sadeler BC. Evolution de la chimiosensibilité de Plasmodium falciparum a la chloroquine et a la méfloquine au Bénin entre 1980 et 1989. Bulletin de la Societé de Pathologie Exotique 83:320-329, 1990.
  • 6. Clyde DF, Mc Carthy VC, Miller RM, Hornick RB. Supressive activity of mefloquine in sporozoite- induced human malaria. Antimicrobial Agents and Chemotherapy 9:384-386, 1976.
  • 7. De Souza JM. Mefloquine clinical trials - Therapeutical experience with mefloquine alone and in combination (MSP) in brazilian male subject with falciparum malaria. Memórias do Instituto Oswaldo Cruz 81(supl Il):259-268, 1986.
  • 8. De Souza JM, Heizmann P, Schwartz DE. Single- dose kineticsof mefloquine in Brazilian male subjects. Bulletin of the World Health Organization 65:353- 356, 1987.
  • 9. Doberstin EB, Phintuyothin P, Noeypatimanondh S, Teerakiartjamjom C. Single-dose therapy of falciparum malaria with mefloquine or pyrimethamine-sulfadoxine. Bulletin of the World Health Organization 57:275-278, 1979.
  • 10. Felix R, Gay F, Lyogoubi A, Bustos MDG, Diquet B, Davis M, Gentilini M. Résistance croiseé a la mefloquine et a l'halofantrine lors d'un paludismea Plasmodium falciparum contracté en Sierra Leone. Bulletin de la Societé de Pathologie Exotique 83:43- 45, 1990.
  • 11. Felix H, Gentilin M. La mefloquine-Rapport preliminaire. In: Resums de le Deuxiéme Congrés de la Societé Mediterranéenne de Chimiotherapie, Nice, France, 1980.
  • 12. Gay F, BinetMH, Bustos MDG, RrouveixB, Danis M, Roy C, Gentilini M. Mefloquine failure in child contracting falciparum malaria in west Africa. The Lancet 355:120-121, 1990.
  • 13. Gilles HM. The treatment and prophy laxis of malaria. Annals of Tropical Medicine and Parasitology 81:607-617, 1987.
  • 14. Greenwood BM. The impact of malaria chemoprophy laxis on the immune status of Africans. Bulletin of the World Health Organization 62(suppl):69-75, 1984.
  • 15. Karwacki JJ, WebsterHK, Limsonwong N, Shanks GD. Two cases of mefloquine resistant malaria in Thailand. Transactions of the Royal Society of Tropical Medicine and Hygiene 83:152-153, 1989.
  • 16. Kiliami VAEB, Mkufya AR, Kilama WL. Low resistance of Plasmodium falciparum to mefloquine in Tanga region Tanzania. Transactions of the Royal Society of Tropical Medicine and Hygiene 83:162- 164, 1989.
  • 17. Kremsner PG, Zotter GM, Feldmeier H, Bienzle V, Jansea-Rosseck R, Graninger W, Rocha M, Wernsdorfer WH. Differences in drug response of Plasmodium falciparum within an area of the Amazon Region. Transactions of the Royal Society of Tropical Medicine and Hygiene 83:158-161, 1989.
  • 18. Maynaidé M, Peceno C, Noriega P-L, Yarzabal L. Susceptibility of Plasmodium falciparum strains to chloroquine and mefloquine in the Amazonas Federal Territory of Venezuela. Transactions of the Royal Society of Tropical Medicine and Hygiene 83:586- 588, 1989.
  • 19. Nosten F, Terkuile F, Chongsuphajaisiddhi T, Luxemburger C, Webster HK, Edstein M, Phaipun L, Kyan LT, White NJ. Mefloquine-resistant falciparum malaria on the Thai-Bumeseborder. The Lancet 337:1140-1143, 1991.
  • 20. PetersW,PortusJ, RobinsonBL. The chemotherapy of rodent malaria. XXVIII, The development of resistance to mefloquine (WR 142,190). Annals of Tropical Medicine and Parasitology 71:419-426, 1977.
  • 21. Petersen E, Hogh B, Bygbjerg IC, Black FT. Malaria chemopropylaxis: Why mefloquine? The Lancet 336:811, 1990.
  • 22. Peto TEA, Gilks CF. Strategies for the prevention of malaria in travellers: comparison ofdrug regimens by means of risk-benefit analy sis. The Lancet 1:1256- 1261, 1986.
  • 23. Phillips-Howard PA, Bjorkman AB. Ascertainment of risk of serious adverse reactions associated with chemoprophylatic antimalarial drugs. Bulletinof the World Health Organization 68:493-504, 1990.
  • 24. Pinotti M, Soares R. A erradicação da malária com sal cloroquinado. Revista Brasileira de Malariologia e Doenças Tropicais 8:253-265, 1956.
  • 25. Ponnapaham JT. Mefloquine in the treatment of malaria a preliminary study. Abstract of the lOth Congress of Tropical Medicine and Malaria. Manila, Philippines p.9-15, 1980.
  • 26. Prata A, Santos JB, Ferreiral, Leimer R. Supressive treatment of malaria in the Amazon Region. In: Abstracts of the XI International Congress of Tropical Medicine and Malaria. Calgary (Canadá) p. 122, 1984.
  • 27. Reyes S, Osanai CH, Passos ADC. Resistência in vivo do Plasmodium falciparum às 4-amino- quino leinas e à associação sulfado xina-pirimetamina. II - Estudo de Manaus, Amazonas 1983-1984. Revista Brasileira de Malariologia e Doenças Tropicais 38:37-44, 1986.
  • 28. Santos JB, Prata A. Tratamento de 75 pacientes portadores de malária pelo P. falciparum em Porto Velho (RO), com mefloquina. Revista da Sociedade Brasileira de Medicina Tropical 21:181-185,1988.
  • 29. Sturchler D. Malaria prophylaxis in travellers: the current position. Experientia 40:1357-1362, 1984.
  • 30. Sturchler D, Handschin J, Kaiser D, Kerr L, Mittelholzer ML, Reber R, Fernex M. Neuropsychiatric side effects of mefloquine. The New England Journal of Medicine 333:1752-1753, 1990.
  • 31. Wemsdorfer WH. Current approaches to malaria chemotherapy and prophylaxis. Parasitology Today 2:220-253, 1986.
  • 32. World Health Organization. Advances in malaria chemotherapy. Technical Repports Series no 711, Geneva, 1984.
  • Endereço para correspondência:

    Dr. João Barberino Santos.
    Centro de Pesquisa e Tratamento de Malária do Vale do Guaporé.
    Av. Limoeiro s/n.
    78971-000
    Costa Marques, RO.
  • Datas de Publicação

    • Publicação nesta coleção
      11 Abr 2013
    • Data do Fascículo
      Set 1993

    Histórico

    • Aceito
      15 Maio 1991
    • Recebido
      15 Maio 1991
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