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Title: Chloroquine versus dihydroartemisinin-piperaquine with standard high-dose primaquine given either for 7 days or 14 days in plasmodium vivax malaria
Authors: Cindy S. Chu
Aung Pyae Phyo
Claudia Turner
Htun Htun Win
Naw Pet Poe
Widi Yotyingaphiram
Suradet Thinraow
Pornpimon Wilairisak
Rattanaporn Raksapraidee
Verena I. Carrara
Moo Kho Paw
Jacher Wiladphaingern
Stéphane Proux
Germana Bancone
Kanlaya Sriprawat
Sue J. Lee
Atthanee Jeeyapant
James Watson
Joel Tarning
Mallika Imwong
François Nosten
Nicholas J. White
Mahidol University
Nuffield Department of Clinical Medicine
Mahidol-Oxford Tropical Medicine Research Unit (MORU)
Keywords: Medicine
Issue Date: 8-Apr-2019
Citation: Clinical Infectious Diseases. Vol.68, No.8 (2019), 1311-1319
Abstract: © 2018 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America. Background Primaquine is necessary for the radical cure of Plasmodium vivax malaria, but the optimum duration of treatment and best partner drug are uncertain. A randomized controlled trial was performed to compare the tolerability and radical curative efficacy of 7-day versus 14-day high-dose primaquine regimens (total dose 7mg/kg) with either chloroquine or dihydroartemisinin-piperaquine. Methods Patients with uncomplicated P. vivax malaria on the Thailand-Myanmar border were randomized to either chloroquine (25mg base/kg) or dihydroartemisinin-piperaquine (dihydroartemisinin 7mg/kg and piperaquine 55mg/kg) plus primaquine, either 0.5 mg/kg/day for 14 days or 1 mg/kg/day for 7 days. Adverse events within 42 days and 1-year recurrence rates were compared and their relationship with day 6 drug concentrations assessed. Results Between February 2012 and July 2014, 680 patients were enrolled. P. vivax recurrences (all after day 35) occurred in 80/654 (12%) patients; there was no difference between treatments. Compared to the 7-day primaquine groups the pooled relative risk of recurrence in the 14-day groups was 1.15 (95% confidence interval 0.7 to 1.8). Hematocrit reductions were clinically insignificant except in G6PD female heterozygotes, 2 of whom had hematocrit reductions to <23% requiring blood transfusion. Conclusion Radical cure should be deployed more widely. The radical curative efficacy in vivax malaria of 7-day high-dose primaquine is similar to the standard 14-day high-dose regimen. Chloroquine and dihydroartemisinin-piperaquine are both highly effective treatments of the blood stage infection. Quantitative point of care G6PD testing would ensure safe use of the 7-day high-dose primaquine regimen in G6PD heterozygous females.
ISSN: 15376591
Appears in Collections:Scopus 2019

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