疟疾诊疗指南

doi:10.12140/j.issn.1000-7423.2022.04.001

摘要/Abstract

摘要：

疟疾是疟原虫感染所致的地方性传染病,主要在热带和亚热带地区流行。尽管世界卫生组织在2021年6月宣布我国通过了消除疟疾认证,但随着国际交流的日益频繁,我国面临的输入性疟疾的威胁将长期存在。为促进临床医师深入了解并合理治疗疟疾,提高疟疾诊治的水平,我们邀请国内感染性疾病及寄生虫病领域相关专家共同编写了“疟疾诊疗指南”（简称“指南”）。该指南对疟疾的病原学、流行病学、发病机制、临床表现、实验室检查、诊断及鉴别诊断、治疗、护理、预防等方面进行介绍,并重点强调了应对不同临床状况时的治疗方案,以便临床医师合理应用。

关键词: 疟疾, 诊断, 治疗, 指南

Abstract:

Malaria is an endemic infectious disease caused by Plasmodium and is mainly prevalent in tropical and subtropical areas. Despite the World Health Organization’s announcement of the country’s malaria elimination certification in 2021, the threat of imported malaria will persist as international travel increases. In order to facilitate clinicians’ understanding and rational treatment of malaria and to improve the diagnosis and treatment of malaria, we have invited experts in the relevant field of infectious diseases and parasitic diseases in China to prepare the guidelines for malaria diagnosis and treatment. The guidelines introduce the etiology, epidemiology, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, treatment, care, and prevention of malaria, emphasising on treatment options for different clinical conditions, so that the clinician can use them properly.

Key words: Malaria, Diagnosis, Treatment, Guidelines

中图分类号:

R531.3

国家传染病医学中心撰写组. 疟疾诊疗指南[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(4): 419-427.

Expert Group of National Center for Infectious Diseases. Guidelines for malaria diagnosis and treatment[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2022, 40(4): 419-427.

图/表 1

表1

基于青蒿素的联合疗法（WHO推荐剂量）

药物名称	剂型	体质量/kg	用法用量
蒿甲醚/苯芴醇	片剂,复方制剂,由蒿甲醚和苯芴醇组成,每片蒿甲醚40 mg + 苯芴醇240 mg		口服,2次/d,共3 d
		5~< 15	蒿甲醚20 mg + 苯芴醇120 mg
		15~< 25	蒿甲醚40 mg + 苯芴醇240 mg
		25~< 35	蒿甲醚60 mg + 苯芴醇360 mg
		≥ 35	蒿甲醚80 mg + 苯芴醇480 mg
青蒿琥酯/阿莫地喹	片剂,复方制剂,由青蒿琥酯和阿莫地喹组成国内剂型：每片青蒿琥酯100 mg+阿莫地喹270 mg 国外剂型还包括：每片青蒿琥酯25 mg + 阿莫地喹67.5 mg 每片青蒿琥酯50 mg + 阿莫地喹135 mg		口服,2次/d,共3 d
		4.5~< 9	青蒿琥酯25 mg + 阿莫地喹67.5 mg
		9~< 18	青蒿琥酯50 mg + 阿莫地喹135 mg
		18~< 36	青蒿琥酯100 mg + 阿莫地喹270 mg
		≥ 36	青蒿琥酯200 mg + 阿莫地喹540 mg
双氢青蒿素/磷酸哌喹	片剂,复方制剂,由双氢青蒿素和磷酸哌喹组成国内剂型：每片双氢青蒿素40 mg + 磷酸哌喹320 mg 国外剂型还包括：每片双氢青蒿素20 mg + 磷酸哌喹160 mg		口服,2次/d,共3 d
		5~< 8	双氢青蒿素20 mg + 磷酸哌喹160 mg
		8~< 11	双氢青蒿素30 mg + 磷酸哌喹240 mg
		11~< 17	双氢青蒿素40 mg + 磷酸哌喹320 mg
		17~< 25	双氢青蒿素60 mg + 磷酸哌喹480 mg
		25~< 36	双氢青蒿素80 mg + 磷酸哌喹640 mg
		36~< 60	双氢青蒿素120 mg + 磷酸哌喹960 mg
		60~< 80	双氢青蒿素160 mg + 磷酸哌喹1 280 mg
		≥ 80	双氢青蒿素200 mg + 磷酸哌喹1 600 mg
青蒿琥酯-甲氟喹	片剂,联合用药,由青蒿琥酯片和甲氟喹片组合包装国内无生产厂家国外剂型包括：每片青蒿琥酯25 mg + 甲氟喹55 mg 每片青蒿琥酯100 mg + 甲氟喹220 mg		口服,1次/d,共服3 d
		5~< 9	青蒿琥酯25 mg + 甲氟喹55 mg
		9~< 18	青蒿琥酯50 mg + 甲氟喹110 mg
		18~< 36	青蒿琥酯100 mg + 甲氟喹220 mg
		≥ 36	青蒿琥酯200 mg + 甲氟喹440 mg
青蒿琥酯-磺胺多辛-乙胺嘧啶	联合用药,由青蒿琥酯片和磺胺多辛-乙胺嘧啶（SP）片组合包装由25 mg/片的青蒿琥酯片和500 mg/片磺胺多辛 + 25 mg乙胺嘧啶的SP片组成		青蒿琥酯：口服,1次/d,共服3 d	磺胺多辛-乙胺嘧啶：口服,首日单次服用
		5~< 10	25 mg	磺胺多辛250 mg + 乙胺嘧啶12.5 mg
		10~< 25	50 mg	磺胺多辛500 mg + 乙胺嘧啶25 mg
		25~< 50	100 mg	磺胺多辛1 000 mg + 乙胺嘧啶50 mg
		≥ 50	200 mg	磺胺多辛1 500 mg + 乙胺嘧啶75 mg
青蒿琥酯-咯萘啶	片剂,复方制剂,由青蒿琥酯和磷酸咯萘啶组成国内无生产厂家国外剂型包括：片剂：每片青蒿琥酯60 mg + 磷酸咯萘啶 180 mg		口服,1次/d,共服3 d
		5~< 8	青蒿琥酯20 mg + 磷酸咯萘啶60 mg（干混悬剂）
		8~< 15	青蒿琥酯40 mg + 磷酸咯萘啶120 mg（干混悬剂）
		15~< 20	青蒿琥酯60 mg + 磷酸咯萘啶180 mg（干混悬剂）
		20~< 24	青蒿琥酯60 mg + 磷酸咯萘啶180 mg（片剂）
		24~< 45	青蒿琥酯120 mg + 磷酸咯萘啶360 mg（片剂）
		45~< 65	青蒿琥酯180 mg + 磷酸咯萘啶540 mg（片剂）
		≥ 65	青蒿琥酯240 mg + 磷酸咯萘啶720 mg（片剂）

表1

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