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Title: Safety of primaquine in infants with Plasmodium vivax malaria in Papua, Indonesia
Authors: Agus Setyadi
Eggi Arguni
Enny Kenangalem
Afdhal Hasanuddin
Daniel A. Lampah
Kamala Thriemer
Nicholas M. Anstey
Paulus Sugiarto
Julie A. Simpson
Ric N. Price
Nicholas M. Douglas
Jeanne R. Poespoprodjo
Melbourne School of Population and Global Health
Mitra Masyarakat Hospital, Indonesia
Universitas Gadjah Mada
Menzies School of Health Research
Mahidol University
Nuffield Department of Clinical Medicine
Royal Darwin Hospital
Mimika District Hospital
Papuan Health and Community Development Foundation
Keywords: Immunology and Microbiology;Medicine
Issue Date: 2-Apr-2019
Citation: Malaria Journal. Vol.18, No.1 (2019)
Abstract: © 2019 The Author(s). Background: Primaquine (PQ) prevents relapses of vivax malaria but may induce severe haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient patients. Data on the safety of primaquine in infants are limited. Methods: A retrospective, hospital-based cohort study of infants aged 1-12 months with vivax malaria was carried out in Timika, Papua province, Indonesia. Risks of admission, death and severe haematological outcomes within 30 days of first presentation were compared between infants who did and did not receive primaquine. Infants were not tested routinely for G6PD deficiency as per local guidelines. Results: Between 2004 and 2013, 4078 infants presented to the hospital for the first time with vivax malaria, of whom 3681 (90.3%) had data available for analysis. In total 1228 (33.4%) infants were aged between 1 and 6 months and 2453 (66.6%) between 6 and 12 months of age. Thirty-three (0.9%) patients received low-dose primaquine (LDP), 174 (4.7%) received high-dose primaquine (HDP), 3432 (93.2%) received no primaquine (NPQ) and 42 patients received either a single dose or an unknown dose of primaquine. The risk of the Hb concentration falling by > 25% to less than 5 g/dL was similar in the LDP or HDP groups (4.3%, 1/23) versus the NPQ group (3.5%, 16/461). Three infants (1.4%) died following receipt of PQ, all of whom had major comorbidities. Seventeen patients (0.5%) died in the NPQ group. None of the infants had documented massive haemolysis or renal impairment. Conclusions: Severe clinical outcomes amongst infants treated with primaquine in Papua were rare. The risks of using primaquine in infancy must be weighed against the risks of recurrent vivax malaria in early life.
ISSN: 14752875
Appears in Collections:Scopus 2019

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