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Evidence summaries

Primaquine at Alternative Dosing Schedules for Preventing Relapse in People with Plasmodium Vivax Malaria.

There appears not to be a difference in malaria recurrence between the 7-day treatment regimen and the standard 14-day treatment regimen of 0.5 mg/kg/day primaquine. Level of evidence: "B"

The quality of evidence is downgraded by imprecise results.

Summary

A Cochrane review [Abstract] 1 included 8 randomized controlled trials (RCTs) of adults and children with P. vivax malaria using any regimen of either chloroquine or an artemisinin-based combination therapy (ACT) plus primaquine with either higher daily doses for 14 days, shorter regimens with the same total dose, or using weekly dosing regimens; compared with the usual standard regimens recommended by the WHO (0.25 or 0.5 mg/kg/day for 14 days), or a comparison of these two WHO-recommended regimens.

The analysis did not detect a difference in recurrence between the 7-day regimen and the standard 14-day regimen of 0.5 mg/kg/day primaquine, and no serious adverse events were reported in G6PD-normal participants taking 0.5 mg/kg/day of primaquine.

Clinical comments

Long primaquine treatment course can be difficult to complete, because primaquine can cause dangerous haemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, meaning that physicians may be reluctant to prescribe in areas where G6PD testing is not available. The shorter regimen may be useful in G6PD-normal patients if there are treatment adherence concerns.

Links

Abstract and full text in Cochrane database http://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012656.pub2/full(licence for full text required)

Abstract in McMaster database (licence required)

Note

Date of latest search: 17 December 2018

    References

    • Milligan R, Daher A, Graves PM. Primaquine at alternative dosing schedules for preventing relapse in people with Plasmodium vivax malaria. Cochrane Database Syst Rev 2019;(7):CD012656. [PubMed]

Primary/Secondary Keywords