High dose of primaquine in primaquine resistant vivax malaria

Bunnag, D; Karbwang, Juntra; Thanavibul, A; Chittamas, S; Ratanapongse, Yupin; Chalermrut, K; Bangchang, Kesara Na; Harinasuta, T

doi:10.1016/0035-9203(94)90305-0

Cited by 78 publications

(77 citation statements)

References 7 publications

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“…This regimen was reported to be 82% effective. 10 Increasing the daily dose to 22.5 mg/day improved the cure rate to 97%. 10 However, the dosage was limited to Յ30 mg/day due to its toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…10 Increasing the daily dose to 22.5 mg/day improved the cure rate to 97%. 10 However, the dosage was limited to Յ30 mg/day due to its toxicity. Although it was reported that the blood schizonticidal effect of primaquine would not be achieved unless used in toxic doses, 12 a recent study showed clinical efficacy in the treatment of P. vivax malaria.…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy of conventional doses is approximately 80%. 10,11 A study conducted at our institute showed improvement of cure rate when the dose was increased. 10 The dosage has been limited to a maximum of 30 mg/day because of toxicity.…”

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confidence: 99%

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Efficacy of primaquine regimens for primaquine-resistant Plasmodium vivax malaria in Thailand.

Wilairatana

Silachamroon²,

Krudsood³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. To define the current efficacy of Fansidar (F. Hoffmann-La Roche Ltd., Basel Switzerland) (pyrimethamine and sulfadoxine), primaquine in a high dose, and artesunate for treating acute Plasmodium vivax malaria, we conducted a comparative clinical trial of these 3 drugs in an open-label study. Patients (15-65 years old) were assigned to 1 of 4 treatments regimens in a serial order. Ninety percent of the patients were infected at Thailand-Myanmar border. Patients in group I (n ϭ 23) received Fansidar (3 tablets, 75 mg of pyrimethamine and 1,500 mg of sulfadoxine, a single dose on the first day), group II (n ϭ 23) received Fansidar (3 tablets, 75 mg of pyrimethamine and 1,500 mg of sulfadoxine, a single dose on the first day) and then received primaquine (30 mg a day for 14 days), group III (n ϭ 23) received primaquine (30 mg a day for 14 days), and group IV (n ϭ 23) received artesunate (200 mg once a day for 3 days) and then primaquine (30 mg a day for 14 days). Cure rates on day 28 of follow-up were 40%, 100%, 100%, and 100% in groups I, II, II, and IV, respectively. There were 4 and 5 patients in group I showing post-treatment reappearance of parasitemia at Յ 16 days and between 17 and 28 days, respectively. Patients in the other 3 groups showed negative parasitemias within 7 days after treatment. Artesunate plus primaquine (group IV) cleared parasitemia faster than the other 3 regimens. There is a high proportion of ineffectiveness of Fansidar for treatment of P. vivax malaria and it should be no longer used for treatment of P. vivax malaria acquired at the Thailand-Myanmar border. A high dose of primaquine is safe and effective in the treatment of P. vivax malaria during the 28-day follow-up period.Plasmodium vivax causes a clinically benign illness but relapse is frequent. It is a common cause of malaria in Asia and South America. In a recent study among a population residing on the western border of Thailand, P. vivax was found in 2,573 (54%) of 4,728 persons over a period of 2 years.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy of primaquine regimens for primaquine-resistant Plasmodium vivax malaria in Thailand.

Wilairatana

Silachamroon²,

Krudsood³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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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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“…2 In Thailand, the current standard treatment for P. vivax malaria is chloroquine, 1,500 mg over 3 days, followed by primaquine, 15 mg a day for 14 days. The acute phase of a P. vivax infection has been successfully treated with chloroquine in Thailand 3 but not in eastern Indonesia. 4 Many studies in Thailand have demonstrated that the standard regimen of primaquine showed relatively high relapse rates.…”

Section: Introductionmentioning

confidence: 99%

High-dose Primaquine Regimens against Relapse of Plasmodium vivax Malaria

Krudsood¹,

Tangpukdee²,

Wilairatana³

et al. 2008

The American Journal of Tropical Medicine and Hygiene

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Abstract. Plasmodium vivax causes debilitating but usually non-lethal malaria in most of Asia and South America. Prevention of relapse after otherwise effective therapy for the acute attack requires a standard daily dose of primaquine administered over 14 days. This regimen has < 90% efficacy in Thailand, and is widely regarded as ineffective because of poor compliance over the relatively long duration of dosing. We evaluated the efficacy, safety, and tolerability of alternative primaquine dosing regimens combined with artesunate among 399 Thai patients with acute, symptomatic P. vivax malaria. Patients were randomly assigned to one of six treatment groups: all patients received artesunate, 100 mg once a day for 5 days. Groups 1-5 then received primaquine, 30 mg a day for 5, 7, 9, 11, and 14 days, respectively. Group 6 received primaquine, 30 mg twice a day for 7 days. The 28-day cure rates were 85%, 89%, 94%, 100%, and 96%, respectively. Treatment of P. vivax malaria with artesunate for 5 days followed by high-dose primaquine, 30 mg twice a day for 7 days, was highly effective, well-tolerated, and equivalent or superior to the standard regimen of primaquine therapy.

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High dose of primaquine in primaquine resistant vivax malaria

Cited by 78 publications

References 7 publications

Efficacy of primaquine regimens for primaquine-resistant Plasmodium vivax malaria in Thailand.

Efficacy of primaquine regimens for primaquine-resistant Plasmodium vivax malaria in Thailand.

Resistance to Therapies for Infection by Plasmodium vivax

High-dose Primaquine Regimens against Relapse of Plasmodium vivax Malaria

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