Primaquina y recurrencias de malaria por Plasmodium vivax. Metanálisis de estudios clínicos controlados

Abstract

Background: Primaquine (PQ) is used against relapses of vivax malaria (RVM) but several aspects about dosage are unknown, as the total effective dose (TD) in a number of days. Objective: To compare PQ regimens against RVM in randomized or non-randomized controlled clinical trials (CCTs). Methodology: Meta-analysis. Information was sought until 31 December, 2012 in Lilacs, SciELO, PubMed (Medline), Cochrane Library, Cochrane Infectious Diseases Group, Embase. Experimental studies or CCT were used, always with concurrent control group. No matter whether or not the design was randomized, close label, supervised. It is not required that the study established difference between relapse and reinfection by molecular evidence. Inclusion and exclusion criteria for articles were applied and meet the inclusion criteria constituted adequate quality to be left in the meta-analysis. Results: 23 ECC with or without random allocation of treatment met the selection criteria. Include four schemes of TD (TD mg-number of days): 210-14 = 210 mg in 14 days; 210-7 = 210 mg in 7 days, 45 to 150 mg in 3 to 10 days, 0 (not PQ). If PQ is absent, recurrences occurr 34.48% versus 19.66% with PQ 210-14 (significant difference), 210-14 showed effectiveness equal to that of 210-7. Treatments 210-7 and 210-14 were statistically better than 45 to 150 effectiveness. Conclusions: The use of PQ is necessary to reduce recurrences and TD 210 mg given at 7 or 14 days is which is more effective but more studies are required to treatment 210-7.

Primaquine at alternative dosing schedules for preventing relapse in people withPlasmodium vivaxmalaria

“…Our findings that 210 mg over 7 days may be as efficacious as 210 mg over 14 days are similar to the findings of other systematic reviews that examined both randomized and non‐randomized studies (Carmona‐Fonseca 2015; Zuluaga‐Idarraga 2015). Other reviews also commented on the difficulty of comparing results due to the varying treatment regimens and length of follow‐up used in clinical trials (John 2012; Carmona‐Fonseca 2015; Zuluaga‐Idarraga 2015).…”

Therapeutic efficacy of alternative primaquine regimens to standard treatment in preventing relapses by Plasmodium vivax: A systematic review and meta-analysis

“…Some previous systematic reviews have compared the therapeutic efficacy of the standard PQ regimen (0.25 mg/Kg/day for 14 days) mostly used to prevent recurrences of P. vivax malaria with other regimens. Including studies until 2012, they have shown that the total doses lower than the standard regimen have lower efficacy 10 , 11 , 25 ; however, none of the previous systematic revisions have focused on evaluating the effectiveness of both PQ regimens currently used in the world as an alternative to improve efficiency or adherence to the standard PQ regimen (0.5 mg/Kg/day for 7 and 0.5 mg/Kg/day for 14 days); therefore, this systematic revision has addressed this comparison.…”

Transmission of malaria from donors to solid organ transplant recipients: A case report and literature review

“…The absence of primaquine in treatment regimens resulted in a recurrence rate of 34.5% compared to a rate of 19.7% with the inclusion of primaquine, indicating a significant advantage for the use of primaquine. 27 Among patients receiving antimalaria treatment, approximately 60% of recurrences occur within the first 3 months, and there are no differences with respect to patient age, the presence of previous malaria episodes, fever duration, physical findings, or the parasite count. Organ transplant recipients with donor-derived malaria should be carefully monitored for 6 to 12 months after treatment to ensure that recurrence does not occur.…”

“…There was a significant difference in the duration of follow-up depending on the patient's geographical location. 27…”

“…After the diagnosis and establishment of management, we noticed the improvement in the patients, which indicated that the symptoms corresponded to infection by Plasmodium in several patients. 26,27…”