Subdoses of primaquine in overweight patients and malaria vivax relapses: report of two cases in the Federal District, Brazil

Santos, João Barberino; Luz, Francisco das Chagas de Oliveira; Deckers, Fernando Augusto Lopes; Tauil, Pedro Luíz

doi:10.1590/s0037-86822010000600033

Cited by 11 publications

(12 citation statements)

References 8 publications

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“…These results agree with studies that suggested dosing adjustments for patients weighting over 70 kg at a time when obesity was not yet a global problem [37-40]. …”

Section: Discussionsupporting

confidence: 90%

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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“…These results agree with studies that suggested dosing adjustments for patients weighting over 70 kg at a time when obesity was not yet a global problem [37-40]. …”

Section: Discussionsupporting

confidence: 90%

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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“…Furthermore, there have been multiple reports of treatment failure from various parts of the world where the older regimen of primaquine had been administered, although some of these may be due to poor compliance (data from Korean peninsula, Afghanistan, India, Vietnam, Thailand) [18-21]. Still, it had been shown that for individuals with a higher bodyweight (> 70 kg), a 15 mg/d primaquine dose was ineffective in preventing relapses even with good compliance [1,22]. Therefore the current recommendation of the Center for Disease Control (CDC), USA for use of primaquine for radical cure stands at 0.5 mg/kg/d for 14 days (maximum of 30 mg/d) [1].…”

Section: Methodsmentioning

confidence: 99%

“…A review of treatment failure with primaquine containing regimens in different endemic areas have shown that while adding primaquine to a blood schizontocidal agent considerably reduced the rate of relapse, the protective effect was more with a higher total dose of primaquine as well as a higher dose per body weight [59]. In some instances of reported failure with primaquine, inadequate dosing compared to body weight of individuals was obvious [22,59,60]. It also questions the validity of earlier case reports of treatment failure with primaquine containing regimens of 15 mg/d (or less than 0.5 mg/kg/d) over 14 days [61-66].…”

Section: Methodsmentioning

confidence: 99%

Primaquine in vivax malaria: an update and review on management issues

Fernando

Rodrigo

Rajapakse

2011

Malar J

137

123

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Primaquine was officially licensed as an anti-malarial drug by the FDA in 1952. It has remained the only FDA licensed drug capable of clearing the intra-hepatic schizonts and hypnozoites of Plasmodium vivax. This update and review focuses on five major aspects of primaquine use in treatment of vivax malaria, namely: a) evidence of efficacy of primaquine for its current indications; b) potential hazards of its widespread use, c) critical analysis of reported resistance against primaquine containing regimens; d) evidence for combining primaquine with artemisinins in areas of chloroquine resistance; and e) the potential for replacement of primaquine with newer drugs.

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“…En algunas zonas endémicas, la malaria coexiste con una alta prevalencia de deficiencia de glucosa 6 fosfato deshidrogenasa (d-G6PD) (5, 6), lo que condiciona el empleo generalizado de la primaquina sin previa evaluación de la existencia de d-G6PD (7). El no uso de la primaquina o su empleo en dosis subterapéuticas facilitan la recaída de P. vivax a partir de los hipnozoítos (8)(9)(10).…”

Section: Introductionunclassified

Evaluación de la eficacia y seguridad de la monoterapia con cloroquina para tratar malaria gestacional aguda no complicada debida P. vivax, Córdoba, Colombia, 2015-2017

Castro-Cavadía

Carmona‐Fonseca

2020

Rev. Colomb. Obstet. Ginecol.

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Objetivo: determinar la eficacia y seguridad de la monoterapia con cloroquina en gestantes colombianas con ataque agudo no complicado de malaria vivax (MGV). Materiales y métodos: estudio de cohorte prospectiva en pacientes gestantes que consultaron de manera espontánea entre 1 febrero de 2015 y 31 diciembre de 2017 a los puestos de malaria o de control prenatal en dos poblaciones de Colombia, en quienes se confirmó el diagnóstico de Plasmodium vivax mediante gota gruesa y qPCR (quantitative polymerase chain reaction). Se midieron variables sociodemográficas, falla terapéutica (FT) y eventos adversos serios a los 28 días y la frecuencia de recurrencia-recaída (RR) con seguimiento de 120 días. Se aplicó el protocolo de la OMS para evaluar la eficacia de monoterapia con cloroquina (m-CQ). Resultados: se captaron 47 gestantes; en el seguimiento de 28 días no hubo pérdidas y hubo 4,2 % (2/47) de FT. En el seguimiento de 45 mujeres entre los días 29 y 120 hubo 11 pérdidas (24,4 % = 11/45) y 13 RR con frecuencia que varió entre 29 y 53 % según el tipo de análisis. Conclusiones: la cloroquina conserva muy alta eficacia para curar el ataque agudo de malaria vivax en malaria gestacional (MG) en Colombia, y continúa siendo una buena opción para el tratamiento de la fase aguda. La frecuencia de RR es alta. Se requieren estudios que evalúen alternativas terapéuticas en la MG. Hay urgente necesidad de disponer de medicamentos o procedimientos que reduzcan ese altísimo riesgo.

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Subdoses of primaquine in overweight patients and malaria vivax relapses: report of two cases in the Federal District, Brazil

Cited by 11 publications

References 8 publications

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

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

Primaquine in vivax malaria: an update and review on management issues

Evaluación de la eficacia y seguridad de la monoterapia con cloroquina para tratar malaria gestacional aguda no complicada debida P. vivax, Córdoba, Colombia, 2015-2017

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