Adherence to 7-Day Primaquine Treatment for the Radical Cure of P. vivax in the Peruvian Amazon

Grietens, Koen Peeters; Soto, Verónica Riquelme; Erhart, Annette; Ribera, Joan Muela; Toomer, Elizabeth; Tenorio, Alex; Montalvo, Tanilu Grande; Rodríguez, Hugo; Cuentas, Alejandro Llanos; D’Alessandro, Umberto; Gamboa, Dionicia

doi:10.4269/ajtmh.2010.09-0521

Cited by 87 publications

(89 citation statements)

References 17 publications

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“…Self-reported intake of all 7 days of the 0.5 mg/kg PQ dose ranged from 86% in Brazil, when all doses were handed at one time, 38 to 78% in Peru under directly observed therapy. 39 Despite the improved chances of compliance versus 14 days, 7-day treatment may still be far from ideal. In addition, 10% relapses in 6 months (or 5-25% as observed in Brazil and Colombia 13,26,40 ) are probably sufficient to maintain transmission in remote settings like the Amazon Basin and probably represent a major challenge to malaria elimination.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Three Different Regimens of Primaquine for the Prevention of Relapses of Plasmodium vivax Malaria in the Amazon Basin of Peru

Durand¹,

Cabezas²,

Lescano³

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. We evaluated the efficacy of three primaquine (PQ) regimes to prevent relapses with Plasmodium vivax through an open-label randomized trial in Loreto, Peru. Vivax monoinfections were treated with chloroquine for 3 days and PQ in three different regimes: 0.5 mg/kg per day for 5 days (150 mg total), 0.5 mg/kg per day for 7 days (210 mg total), or 0.25 mg/kg per day for 14 days (210 mg total). Biweekly fever assessments and bimonthly thick smears were taken for 210 days. Recurrences after 35 days were considered relapses. One hundred eighty cases were enrolled in each group; 90% of cases completed follow-up. There were no group-related differences in age, sex, or parasitemia. Relapse rates were similar in the 7-and 14-day regimes (16/156 = 10.3% and 22/162 = 13.6%, P = 0.361) and higher in the 5-day group (48/169 = 28.4%, P 0.001 and P = 0.001, respectively). The 7-day PQ regimen used in Peru is as efficacious as the recommended 14-day regimen and superior to 5 treatment days.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Three Different Regimens of Primaquine for the Prevention of Relapses of Plasmodium vivax Malaria in the Amazon Basin of Peru

Durand¹,

Cabezas²,

Lescano³

et al. 2014

The American Society of Tropical Medicine and Hygiene

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“…Plasmodium vivax malaria transmission is maintained in human populations by relapses from dormant liver parasite stages (i.e., hypnozoites),10 for which no diagnostic test exists11; treatment with primaquine (PQ) in Peru is given, but effectiveness is unclear because administration is not typically supervised 12. The presence of PQ resistance or compliance has not been systemically assessed under either routine or clinical trial conditions.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Plasmodium vivax Malaria in Peru

Aguirre¹,

Gamboa²,

Manrique³

et al. 2016

Am J Trop Med Hyg

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Malaria in Peru, dominated by Plasmodium vivax, remains a public health problem. The 1990s saw newly epidemic malaria emerge, primarily in the Loreto Department in the Amazon region, including areas near to Iquitos, the capital city, but sporadic malaria transmission also occurred in the 1990s–2000s in both north-coastal Peru and the gold mining regions of southeastern Peru. Although a Global Fund-supported intervention (PAMAFRO, 2005–2010) was temporally associated with a decrease of malaria transmission, from 2012 to the present, both P. vivax and Plasmodium falciparum malaria cases have rapidly increased. The Peruvian Ministry of Health continues to provide artemesinin-based combination therapy for microscopy-confirmed cases of P. falciparum and chloroquine–primaquine for P. vivax. Malaria transmission continues in remote areas nonetheless, where the mobility of humans and parasites facilitates continued reintroduction outside of ongoing surveillance activities, which is critical to address for future malaria control and elimination efforts. Ongoing P. vivax research gaps in Peru include the following: identification of asymptomatic parasitemics, quantification of the contribution of patent and subpatent parasitemics to mosquito transmission, diagnosis of nonparasitemic hypnozoite carriers, and implementation of surveillance for potential emergence of chloroquine- and 8-aminoquinoline-resistant P. vivax. Clinical trials of tafenoquine in Peru have been promising, and glucose-6-phosphate dehydrogenase deficiency in the region has not been observed to be a limitation to its use. Larger-scale challenges for P. vivax (and malaria in general) in Peru include logistical difficulties in accessing remote riverine populations, consequences of government policy and poverty trends, and obtaining international funding for malaria control and elimination.

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“…Several studies highlight that even in areas where PQ is recommended, in practice it is prescribed rarely. 118 Some endemic countries recommend the use of PQ with warnings on its potential toxicity in G6PD-deficient patients, but most do not (see Figure 6). 33 The lack of an available POC G6PD test means that the practitioner who prescribes a radical curative course of PQ risks inducing potentially serious hemolysis if the patient is G6PD deficient.…”

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confidence: 99%