BACKGROUND Intravenous artesunate and its follow on full course dihydroartemisinin-piperaquine are the standard treatment for severe malaria in Indonesia. The current policy suggests that intravenous and oral quinine could be used when standard therapy is not available. Its pragmatic use of both treatment combinations in a field hospital is evaluated. METHODS A retrospective study among hospitalized malaria patients receiving intravenous anti-malarial treatments at Mitra Masyarakat Hospital, Timika from April 2004 to December 2013 was conducted. The length of hospital stay (LoS) and the risk of malaria recurrence within 28 days after hospital admission were compared between patients receiving intravenous artesunate and oral dihydroartemisinin-piperaquine (Iv Art + DHP) and those receiving intravenous and oral quinine (Iv + Oral Qu). RESULTS Of 10,514 patients requiring intravenous therapy, 2759 received Iv + Oral Qu and 7755 received Iv Art + DHP. Plasmodium falciparum infection accounted for 65.8% (6915), while Plasmodium vivax, Mixed infections, Plasmodium malariae and Plasmodium ovale were accounted for 17.0% (1789), 16.4% (1729), 0.8% (79) and 0.01% (2) of the infections, respectively. The majority of severe malaria hospital admissions were highland Papuans (78.0%, 8201/10,501). In total 49% (5158) of patients were older than 15 years and 3463 (32.9%) were children under 5 years old. The median LoS was shorter in patients receiving intravenous artesunate compared to those treated with intravenous quinine (median = 2 [IQR 1-3] versus 3 days [IQR 2-4], p < 0.0001). Patients treated with intravenous quinine had higher risk of being hospitalized longer than 2 days (aOR of 1.70 [95% CI 1.54-1.88], p < 0.0001). The risk of recurrences within 28 days after hospital admission was 1.94 times higher (95% CI aHR 1.57-2.39, p < 0.0001) in patients receiving intravenous quinine with follow on oral quinine treatment than in patients treated with DHP after intravenous artesunate therapy. CONCLUSIONS Intravenous artesunate reduced the LoS of malaria patients and in combination with DHP reduced the risk of malaria recurrence within 28 days after hospital admission compared to those with Iv + Oral Qu treatment. Thus, ensuring continuous supply of intravenous artesunate and artemisinin-based combination therapy (ACT) should be a priority.

中文翻译：

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静脉注射青蒿素加口服双氢青蒿素哌喹或静脉注射奎宁加口服奎宁是严重疟疾的最佳治疗方法：从印度尼西亚巴布亚蒂米卡的一家野战医院汲取的经验教训。

背景静脉注射青蒿琥酯及其后续全程双氢青蒿素哌喹是印度尼西亚严重疟疾的标准治疗方法。目前的政策建议，当无法获得标准治疗时，可以使用静脉注射和口服奎宁。评估了这两种治疗组合在野战医院的实际使用情况。方法 对 2004 年 4 月至 2013 年 12 月在蒂米卡 Mitra Masyarakat 医院接受静脉抗疟疾治疗的住院疟疾患者进行回顾性研究。比较静脉注射青蒿素联合哌喹（Iv Art + DHP）和静脉联合口服奎宁（Iv + Oral Qu）患者的住院时间（LoS）和入院后28天内疟疾复发的风险。 ）。结果 在 10,514 名需要静脉治疗的患者中，2759 名接受 Iv + Oral Qu，7755 名接受 Iv Art + DHP。恶性疟原虫感染占65.8%（6915人），间日疟原虫、混合感染、三日疟原虫和卵形疟原虫分别占17.0%（1789人）、16.4%（1729人）、0.8%（79人）和0.01%（2人）。分别是感染情况。大多数因严重疟疾住院的人是高原巴布亚人（78.0%，8201/10,501）。总共 49% (5158) 的患者年龄超过 15 岁，3463 (32.9%) 是 5 岁以下儿童。与静脉注射奎宁治疗的患者相比，接受静脉注射青蒿琥酯治疗的患者的中位 LoS 较短（中位 = 2 天 [IQR 1-3] 与 3 天 [IQR 2-4]，p < 0.0001）。静脉注射奎宁治疗的患者住院时间超过 2 天的风险较高（aOR 为 1.70 [95% CI 1.54-1.88]，p < 0.0001）。接受静脉注射奎宁并随后口服奎宁治疗的患者入院后 28 天内复发的风险比静脉注射青蒿琥酯治疗后接受 DHP 治疗的患者高 1.94 倍（95% CI aHR 1.57-2.39，p < 0.0001）。结论 与静脉注射+口服曲治疗相比，静脉注射青蒿琥酯可降低疟疾患者的LoS，并与DHP联用可降低入院后28天内疟疾复发的风险。因此，确保静脉注射青蒿琥酯和青蒿素联合疗法（ACT）的持续供应应该是当务之急。