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• W2601022563 abstract "Autorkorrektur! © Georg Thieme Verlag 4 Kasuistik | Case report Dtsch Med Wochenschr 2008; 133: 1–4 · Pisa Joachim Richter, Parenterale Chinin-Artesunat-Kombinationstherapie bei ... Investigations: Microscopy of stained thin and thick blood films revealed Plasmodium falciparum trophzoites with a high parasitaemia of 50% and confirmed the clinical suspicion of a lifethreatening malaria. Treatment and course: Immediate intravenous quinine with a loading dose of 20 mg/kg body weight was initiated followed by 10 mg/kg every 8 hrs. Since the patient lost consciousness, artesunate was added six hours later in the recommended dose of 2.4 mg/kg immediately, repeated after 12 and 24 hrs, followed by a daily dose of 2.4 mg/kg. Furthermore, clindamycin at a dose of 20 mg/kg body weight / d i.v. was given. Anaemia was corrected by 4 erythrocyte concentrates until a haemoglobina concentration of 9.6 g/dl was reached. Now the patient rapidly recovered, and parasitaemia dropped to 0.1% within 24 hrs. Already the following day blood films cleared completely from malaria parasites. Conclusion: The case illustrates the rapid efficacy of a combined parenteral quinine-artesunate therapy in life-threatening falciparum malaria with an unusually high parasitaemia. Literatur 1 Adjuik M, Babiker A et al. Artesunate combinations for treatment of malaria: a meta-analysis. Lancet 2004; 363: 9–17 2 Ashley EA, White NJ. Artemisinin-based combinations. Curr Opinion Inf Dis 2005; 18: 531–536 3 Burchard GD. Malaria. Der Internist 2006; 8: 818–24 4 Burchard GD, Bialek R, Fleischer K fur die Deutsche Gesellschaft fur Tropenmedizin und Internationale Gesundheit. Leitlinie Tropenmedizin: Malaria Arbeitsgemeinschaft der Medizinischen Fachgesellschaften www.uni-duesseldorf.de/WWW/AWMF/ll/042–001.htm; letzter Zugang 13.03.08 5 Dondorp A, Nosten F et al for the South East Asian Quinine Artesunate Trial Group (SEAQUAMAT) . Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet 2005; 366 (9487): 717–25 6 Lell B, Kremsner PG. Clindamycin as an atimalarial drug: review of clinical trials. Antimicrob Agents Chemother 2002; 46 (8): 2315– 23200■ 7 Newton PN, Chierahul W et al. A comparison of artesunate alone with combined artesunate and quinine in the parenteral treatment of acute falciparum malaria. Trans R Soc Trop Med Hyg 2001; 95 (5): 519–23 8 Newton PN, Angus BJ et al. Randomized comparison of artesunate and quinine in the treatment of severe falciparum malaria. Clin Infect Dis 2003; 37 (1): 7–16 9 Nosten White N. Artemisinin-based combination treatment of falciparum malaria. Am J Trop Med Hyg 2007; 77: 181–192 10 Ramharter M, Oyakhirome S et al. Artesunate-clindamycin versus quinine-clindamycin in the treatment of Plasmodium falciparum malaria: a randomized controlled trial. Clin Infect Dis 2005; 40 (12): 1777–1784 11 Reichard U, Moller H, Eiffert H, Ramadori G, Schworer H. Erfolgreiche Therapie einer Malaria tropica mit 50%-iger Parasitamie. Dtsch Med Wochenschr 2006; 1313: 2010–2012 12 Richter J, de Bernardis C et al. Is ultrasound a useful adjunct for assessing malaria patients? Parasitol Res 2004; 94 (5): 349–353 13 Richter J, Jelinek T, Burchard GD. Malaria tropica: Chininum dihydrochloricum: „Orphan drug“-Status gefordert. Deutsches Arzteblatt 2005; 102, Ausgabe 46: A-3164 / B-2672 / C-2502– 14 Riddle MS, Jackson JL, Sanders JW, Blazes DL. Exchange transfusion as an adjunct therapy in severe Plasmodium falciparum malaria: a metaanalysis. Clin Inf Dis 2002; 34: 1192–1198 15 Toovey S. Artesunate versus quinine for severe falciparum malaria. Lancet 2006; 367 (9505): 111– 16 White NJ. Malaria.In: Cook GC, Zumla A, ed (Hrsg). Manson’s Tropical Diseases. 21th edition. Saunders, 2002: 1205–1295 Autorkorrektur! © Georg Thieme Verlag" @default.
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• W2601022563 title "Parenterale Chinin-Artesunat-Kombinationstherapie bei lebensbedrohlicher Malaria Parenteral combined quinine-artesunate therapy in life-threatening malaria" @default.
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