Shorter, Simpler Treatments to Prevent Malaria Relapse

Clinical Takeaway

: High-dose primaquine for 7 days and single-dose tafenoquine were more effective than standard primaquine doses to prevent recurrent Plasmodium vivax infections; patients with normal G6PD levels tolerated all three treatments well.

Context

Reactivation of dormant Plasmodium vivax hypnozoites in the liver causes relapses of vivax malaria. Only two drugs are available to clear liver-stage parasites. Both can cause hemolysis in patients deficient in G6PD. To avoid this complication, in settings where routine G6PD testing is unavailable, clinicians give primaquine in low doses over 14 days, but compliance is poor and failures common. In a four-country, open-label, superiority trial, 960 adult patients with vivax malaria and normal (>70%) G6PD levels received standard (for each country) acute blood-stage malaria treatment. Researchers then randomly assigned patients (1:1:1) to receive one of three treatments: 7 days of high-dose primaquine (total dose, 7 mg/kg), single-dose…

Reviewing Author

Mary E. Wilson, M.D.

Disclosures

Consultant/Advisory BoardOneHealthTrust (formerly Center for Disease Dynamics, Economics, and Policy); Global Health Institute, University of Wisconsin

RoyaltiesUpToDate

Editorial BoardsJournal of Travel Medicine