Primaquine for preventing relapses in people with Plasmodium vivax malaria

Abstract

Primaquine (15 mg/kg/day for 14 days) plus chloroquine is more effective than chloroquine alone or primaquine (15 mg/kg for 5 days) plus chloroquine in preventing relapses of vivax malaria. Primaquine (five days) plus chloroquine appears no better than chloroquine. Countries should follow the WHO's recommendation for 14-day primaquine plus chloroquine regimen. Alternative regimens need to be evaluated in randomized controlled trials, which should also consider variations in regional P. vivax strains and the possibility of primaquine resistance, reinfection, and adherence in those who relapse.

Primaquina y recurrencias de malaria por Plasmodium vivax. Metanálisis de estudios clínicos controlados

“…In Lilacs, four references were found, though only one was CCT. In Cochrane Library there were six references and only two on recurrences of vivax malaria 6,13 . In Cochrane Infectious Diseases Group, we found the same as in Cochrane Library.…”

“…The alkylation of the amine group in position eight with a lateral chain of five carbons and a terminal amine confers it with great power [1][2][3][4][5][6] . PQ seems more efficient when it occurs simultaneously with the blood schozonticides 2 and, from all antimalarials, this is the one which has the wider activity spectrum 3 .…”

“…PQ seems more efficient when it occurs simultaneously with the blood schozonticides 2 and, from all antimalarials, this is the one which has the wider activity spectrum 3 . The PQ has proven highly useful for simple primary and secondary chemoprophylaxis 4 or against recurrences [5][6][7][8] . The total dosis (TD) of 210 mg given in 14 days (210-14), for an adult weighting 60 kg (0.25 mg/kg/day for 14 days), is recommended by the WHO as the stardard in order to avoid recurrences 7 .…”

“…The clinical and parasitary cure, which include avoiding recurrences of the infection by P. cynomolgi and P. vivax is the role of the TD of the 8-AQ 9,10 . There are several recent reviews on the use of PQ to avoid the recurrences 3,11,12 , as well as meta-analysis on the theme 5,6,[13][14][15] . The 2 meta-analysis of Cochrane 6,13 assessed random and semi-random controlled clinical trials (CCT) in humans who compared treatments with chloroquine only against chloroquine added with PQ, given as 210-14, and other PQ schemes.…”

Diagnosis and Treatment of Plasmodium vivax Malaria

“…78 A better indication of PQ efficacy requires comparison with a control arm in which patients receive no PQ, thus controlling for background reinfection and relapse patterns. 105,106 There have been 18 published studies with control arms. Of these, the effectiveness of a very low-dose PQ regimen was no different from patients who did not receive PQ, whereas for the low-dose regimens, a significant difference was reported in half of the studies (overall odds ratio [OR]: 0.14, 95% confidence interval [CI]: Two recent studies from Indonesia documented good efficacy (> 95%) against relapse in P. vivax among soldiers followed for a year (without risk of reinfection) after directly observed high-dose PQ therapy either following 107 or concurrent with ACT.…”