Adequate Primaquine for Vivax Malaria

Kitchener, Scott; Nasveld, Peter; Bennett, Sonya M.; Torresi, Joseph

doi:10.2310/7060.2005.12306

Cited by 10 publications

(10 citation statements)

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“…Notwithstanding these encouraging findings, caution needs to be exercised because P. vivax relapses may occur up to more than six months after acute infections and that a higher dose of primaquine (30 mg/day for 14 days) might have prevented more relapses. 3 The patient relapsing in this study after chloroquine and tafenoquine treatment had markedly lower plasma tafenoquine concentrations for the first six weeks after commencing tafenoquine treatment compared with those who where successfully treated with the drug combination. His low plasma tafenoquine concentrations suggest that he experienced difficulty in absorbing the drug after the commencement of treatment.…”

mentioning

confidence: 64%

“…These infections required increasing doses of primaquine to adequately prevent relapse. 3 In an effort to eliminate these primaquine-tolerant parasites, we evaluated chloroquine and an extended treatment course of tafenoquine (formerly known as WR 238605), a primaquine analog, to see whether such a regimen would be more efficacious than chloroquine and primaquine. We report the effectiveness and tolerability of this open-label, prospective use of tafenoquine given over 8 weeks as treatment for P. vivax malaria after a standard course of chloroquine (1,500 mg total dose) to treat the acute attack.…”

mentioning

confidence: 99%

“…The tafenoquine course was selected on the basis of the lengthy elimination half-life for tafenoquine of 2 weeks, 4 which would lead to persistent drug blood concentrations to at least the median time to relapse (approximately 90 days) noted previously in this population. 3,5 Further support for the 8-week tafenoquine treatment course is the high effectiveness of a single 45 mg-dose of primaquine administered once a week for 8 weeks against Chesson P. vivax infections. 6 Observation throughout the eight weeks of active treatment included clinical assessment, blood films for parasitemia, and blood samples collected for measurement of plasma tafenoquine concentrations.…”

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confidence: 99%

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Tafenoquine for the Treatment of Recurrent Plasmodium Vivax Malaria

Kitchener

Nasveld²,

Edstein³

2007

The American Journal of Tropical Medicine and Hygiene

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Tafenoquine was used to treat Plasmodium vivax malaria cases who had previously failed treatment with chloroquine and primaquine. Chloroquine was followed by a loading dose of tafenoquine (200 mg base/day for 3 days) and 200 mg a week was given for 8 weeks. One of 27 treated patients relapsed after 6 months of observation. A standard course of chloroquine administered with 8 weeks of tafenoquine may be more effective than chloroquine with primaquine (22.5 mg/day for 14 days) in preventing additional P. vivax relapses. Larger studies are required to optimize the combination, but our findings suggest that an extended use of tafenoquine may be required to prevent relapses of primaquine-tolerant strains of P. vivax malaria.

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confidence: 64%

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confidence: 99%

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confidence: 99%

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Tafenoquine for the Treatment of Recurrent Plasmodium Vivax Malaria

Kitchener

Nasveld²,

Edstein³

2007

The American Journal of Tropical Medicine and Hygiene

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“…However, Duarte et al [15] in Cuiaba, Brazil and Kitchener et al [16] in Melbourne, Australia, prospectively followed patients for two years and showed relapse rates of 14% in 50 patients and 24% in 318 patients, respectively. The higher frequency recorded (40%) could be explained by the smaller sample in this study or by the fact that data for Brazil obtained in 2005-2011 were compared to data obtained in 1991 and in 2003, and concern with primaquine tolerance may have been different in these two periods.…”

Section: Discussionmentioning

confidence: 99%

Plasmodium vivax malaria relapses at a travel medicine centre in Rio de Janeiro, a non-endemic area in Brazil

Pedro

Guaraldo

Campos

et al. 2012

Malar J

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BackgroundMalaria is a potentially severe disease widely distributed in tropical and subtropical regions worldwide. Clinically, the progression of the disease can be life-threatening if it is not promptly diagnosed and properly treated. Through treatment, the radical cure of Plasmodium vivax infection can be achieved, thus preventing potential relapses and the emergence of new cases outside the Amazon region in Brazil. Surveillance for therapeutic failure in non-endemic areas is advantageous, as it is unlikely that recurrence of the disease can be attributed to a new malaria infection in these regions.MethodsAn observational study of 53 cases of P. vivax and mixed (P. vivax and Plasmodium falciparum) malaria was conducted at a travel medicine centre between 2005 and 2011 in Rio de Janeiro and a descriptive analysis of the potential factors related to recurrence of P. vivax malaria was performed. Groups with different therapeutic responses were compared using survival analysis based on the length of time to recurrence and a set of independent variables thought to be associated with recurrence.ResultsTwenty-one relapses (39.6%) of P. vivax malaria were observed. The overall median time to relapse, obtained by the Kaplan-Meier method, was 108 days, and the survival analysis demonstrated an association between non-weight-adjusted primaquine dosing and the occurrence of relapse (p < 0.03). Primaquine total dose at 3.6 mg/kg gave improved results in preventing relapses.ConclusionsA known challenge to individual cure and environmental control of malaria is the possibility of an inappropriate, non-weight-based primaquine dosing, which should be considered a potential cause of P. vivax malaria relapse. Indeed, the total dose of primaquine associated with non-occurrence of relapses was higher than recommended by Brazilian guidelines.

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“…Although Luxemburger et al (137) found a 91% efficacy of 15 mg daily for 14 days with 2 months of follow-up, Walsh et al (232) and Pukrittayakamee et al (174) measured efficacies of that regimen to be 69% and 42%, respectively. Standard 14-day therapy of 15 mg daily failed more often than either the 22.5-or 30-mg daily regimen (34,174), and the 22.5-mg daily regimen failed more often than did the 30-mg daily regimen (117). Likewise, a 30-mg daily dose works better when given for 11 or 14 days than when given just 5, 7, or 9 days (127).…”

Section: Distributionmentioning

confidence: 99%

Resistance to Therapies for Infection by Plasmodium vivax

2009

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SUMMARY The gravity of the threat posed by vivax malaria to public health has been poorly appreciated. The widely held misperception of Plasmodium vivax as being relatively infrequent, benign, and easily treated explains its nearly complete neglect across the range of biological and clinical research. Recent evidence suggests a far higher and more-severe disease burden imposed by increasingly drug-resistant parasites. The two frontline therapies against vivax malaria, chloroquine and primaquine, may be failing. Despite 60 years of nearly continuous use of these drugs, their respective mechanisms of activity, resistance, and toxicity remain unknown. Although standardized means of assessing therapeutic efficacy against blood and liver stages have not been developed, this review examines the provisional in vivo, ex vivo, and animal model systems for doing so. The rationale, design, and interpretation of clinical trials of therapies for vivax malaria are discussed in the context of the nuance and ambiguity imposed by the hypnozoite. Fielding new drug therapies against real-world vivax malaria may require a reworking of the strategic framework of drug development, namely, the conception, testing, and evaluation of sets of drugs designed for the cure of both blood and liver asexual stages as well as the sexual blood stages within a single therapeutic regimen.

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Adequate Primaquine for Vivax Malaria

Abstract: The available data presented here suggest that vivax malaria in this region is increasingly tolerant of the 22.5 mg daily treatment regimen of primaquine and that the greater dose of at least 30 mg daily is more effective.

Cited by 10 publications

References 8 publications

Tafenoquine for the Treatment of Recurrent Plasmodium Vivax Malaria

Tafenoquine for the Treatment of Recurrent Plasmodium Vivax Malaria

Plasmodium vivax malaria relapses at a travel medicine centre in Rio de Janeiro, a non-endemic area in Brazil

Resistance to Therapies for Infection by Plasmodium vivax

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