Primaquine for reducing transmission of Plasmodium falciparum malaria

Graves, Patricia M.; Gelband, Hellen; Ribeiro, Isabela

doi:10.1002/14651858.cd008152

Cited by 14 publications

(25 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Primaquine is the only licensed medicine for the treatment of P. vivax hypnozoites [20]. Moreover, the transmissible stages of P. falciparum (i.e., gametocytes) are sensitive to primaquine [35]. As recommended by the World Health Organization (WHO), administering a single dose or short course of primaquine in conjunction with the primary treatment for P. falciparum infection can reduce the transmission of the parasite from the patient to mosquitoes [36].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in southeast Iran: implications for malaria elimination

Tabatabaei

Khorashad

Sakeni

et al. 2015

J Infect Dev Ctries

View full text Add to dashboard Cite

Introduction: Glucose-6-phosphate dehydrogenase deficiency (G6PD) is an X-linked genetic disorder with a relatively high frequency in malaria-endemic regions. It is an obstacle to malaria elimination, as primaquine administered in the treatment of malaria can cause hemolysis in G6PD-deficient individuals. This study presents information on the prevalence of G6PD deficiency in Sistan and Balouchetsan province, which hosts more than 90% of Plasmodium vivax malaria cases in Iran. This type of information is needed for a successful malaria elimination program. Methodology: A total of 526 students were randomly recruited through schools located in southeast Iran. Information was collected by interviewing the students using a structured questionnaire. Blood samples taken on filter papers were examined for G6PD deficiency using the fluorescent spot test. Results: Overall, 72.8% (383/526) of the subjects showed normal G6PD enzyme function. Mild and severe G6PD deficiency was observed in 14.8% (78) and 12.2% (64) of subjects, respectively. A total 193/261 males (73.9%) and 190/265 (72%) females had normal enzyme activity. Mild G6PD deficiency was observed in 10.8% (28) and 18.9% (50) of male and female subjects, respectively. However, in comparison with females, a greater proportion of males showed severe enzyme deficiency (15.3% versus 9.1%). All these differences were statistically significant (p < 0.006). Conclusions: G6PD deficiency is highly prevalent in southeast Iran. G6PD-deficient individuals are susceptible to potentially severe and lifethreatening hemolytic reactions after primaquine treatment. In order to achieve malaria elimination goals in the province, G6PD testing needs to be made routinely available within the health system.

show abstract

Section: Discussionmentioning

confidence: 99%

Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in southeast Iran: implications for malaria elimination

Tabatabaei

Khorashad

Sakeni

et al. 2015

J Infect Dev Ctries

View full text Add to dashboard Cite

show abstract

“…Is the current evidence base sufficient to inform widespread use? Are population-level efficacy and the risk of serious adverse events predictable [8,19,20]? What constitutes an acceptable loss of hemoglobin or hematocrit?…”

mentioning

confidence: 99%

“…A lower dose of 0.1 mg/kg reduced gametocyte density but did not result in clearance, and the authors queried whether these gametocytes were infectious, suggesting that infectivity studies using this dose should be carried out. Indeed, two recent Cochrane reviews on singledose primaquine expressed the need for infectivity studies of primaquine with ACT partner drugs [19,20]. Importantly, there remains a need to validate the efficacy of the WHOrecommended 0.25 mg/kg single dose of primaquine.…”

mentioning

confidence: 99%

“…COMM.]. However, the actual level of policy implementation is unclear, as healthcare workers may be reluctant to prescribe primaquine due to safety concerns arising from use of the drug for the radical cure of P. vivax malaria [19,37]. In malaria elimination settings, policy uptake has been slower, with Botswana, Ethiopia, Namibia, South Africa, Swaziland, Zanzibar and Zimbabwe very recently incorporating primaquine in policy documents [ To facilitate the use of primaquine for malaria elimination, stakeholders convened in 2012 and 2014 to identify critical barriers to rollout in sub-Saharan Africa, where 90% of G6PDd individuals are of the mildly primaquine-sensitive A-variant [8,38,39].…”

mentioning

confidence: 99%

“…While defining the therapeutic range, conducting active safety monitoring, and studying the potential for drug-drug interactions will provide the basic knowledge to support the programmatic use of primaquine for P. falciparum elimination, the translation of individual-level efficacy to population-level benefits will be challenging [19]. There are three strategies under consideration for primaquine use to target P. falciparum transmission.…”

mentioning

confidence: 99%

See 2 more Smart Citations

TargetingPlasmodium falciparumtransmission with primaquine: same efficacy, improved safety with a lower dose?

Chen

Gosling

2014

Expert Review of Clinical Pharmacology

View full text Add to dashboard Cite

Primaquine or other 8-aminoquinolines for reducing Plasmodium falciparum transmission

Graves

Choi

Gelband³

et al. 2018

Cochrane Database of Systematic Reviews

Self Cite

View full text Add to dashboard Cite

Background The 8‐aminoquinoline (8AQ) drugs act on Plasmodium falciparum gametocytes, which transmit malaria from infected people to mosquitoes. In 2012, the World Health Organization (WHO) recommended a single dose of 0.25 mg/kg primaquine (PQ) be added to malaria treatment schedules in low‐transmission areas or those with artemisinin resistance. This replaced the previous recommendation of 0.75 mg/kg, aiming to reduce haemolysis risk in people with glucose‐6‐phosphate dehydrogenase deficiency, common in people living in malarious areas. Whether this approach, and at this dose, is effective in reducing transmission is not clear. Objectives To assess the effects of single dose or short‐course PQ (or an alternative 8AQ) alongside treatment for people with P. falciparum malaria. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; and the WHO International Clinical Trials Registry Platform (ICRTP) portal using ‘malaria*', ‘falciparum', ‘primaquine', ‘8‐aminoquinoline', and eight 8AQ drug names as search terms. We checked reference lists of included trials, and contacted researchers and organizations. Date of last search: 21 July 2017. Selection criteria Randomized controlled trials (RCTs) or quasi‐RCTs in children or adults, adding PQ (or alternative 8AQ) as a single dose or short course alongside treatment for P. falciparum malaria. Data collection and analysis Two authors screened abstracts, applied inclusion criteria, and extracted data. We sought evidence on transmission (community incidence), infectiousness (people infectious and mosquitoes infected), and potential infectiousness (gametocyte measures assessed by microscopy or polymerase chain reaction [PCR]). We grouped trials into artemisinin and non‐artemisinin treatments, and stratified by PQ dose (low, 0.2 to 0.25 mg/kg; moderate, 0.4 to 0.5 mg/kg; high, 0.75 mg/kg). We used GRADE, and absolute effects of infectiousness using trial control groups. Main results We included 24 RCTs and one quasi‐RCT, comprising 43 arms. Fourteen trials evaluated artemisinin treatments (23 arms), nine trials evaluated non‐artemisinin treatments (13 arms), and two trials included both artemisinin and non‐artemisinin arms (three and two arms, respectively). Two trial arms used bulaquine. Seven PQ arms used low dose (six with artemisinin), 11 arms used moderate dose (seven with artemisinin), and the remaining arms used high dose. Fifteen trials tested for G6PD status: 11 excluded participants with G6PD deficiency, one included only those with G6PD deficiency, and three included all, irrespective of status. The remaining 10 trials either did not test or did not report on testing. No cluster trials ev...

show abstract

Primaquine for reducing transmission of Plasmodium falciparum malaria

Cited by 14 publications

References 19 publications

Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in southeast Iran: implications for malaria elimination

Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in southeast Iran: implications for malaria elimination

TargetingPlasmodium falciparumtransmission with primaquine: same efficacy, improved safety with a lower dose?

Primaquine or other 8-aminoquinolines for reducing Plasmodium falciparum transmission

Contact Info

Product

Resources

About