Simple jQuery Dropdowns
Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/51792
Title: The tolerability of single low dose primaquine in glucose-6-phosphate deficient and normal falciparum-infected Cambodians
Authors: Lek Dysoley
Saorin Kim
Sergio Lopes
Nimol Khim
Steven Bjorges
Samphornarann Top
Chea Huch
Huy Rekol
Nelli Westercamp
Mark M. Fukuda
Jimee Hwang
Arantxa Roca-Feltrer
Mavuto Mukaka
Didier Menard
Walter R. Taylor
Institut Pasteur du Cambodge
Centers for Disease Control and Prevention
Mahidol University
Nuffield Department of Clinical Medicine
Institut Pasteur, Paris
Malaria Consortium
Cambodia Country Office
National Institute of Public Health
National Centre for Parasitology, Entomology and Malaria Control
Keywords: Medicine
Issue Date: 12-Mar-2019
Citation: BMC Infectious Diseases. Vol.19, No.1 (2019)
Abstract: © 2019 The Author(s). Background: The WHO recommends single low-dose primaquine (SLDPQ, 0.25 mg/kg body weight) in falciparum-infected patients to block malaria transmission and contribute to eliminating multidrug resistant Plasmodium falciparum from the Greater Mekong Sub region (GMS). However, the anxiety regarding PQ-induced acute haemolytic anaemia in glucose-6-phosphate dehydrogenase deficiency (G6PDd) has hindered its use. Therefore, we assessed the tolerability of SLDPQ in Cambodia to inform national policy. Methods: This open randomised trial of dihydroartemisinin-piperaquine (DHAPP) + SLDPQ vs. DHAPP alone recruited Cambodians aged ≥1 year with acute uncomplicated P. falciparum. Randomisation was 4:1 DHAPP+SLDPQ: DHAPP for G6PDd patients and 1:1 for G6PDn patients, according to the results of the qualitative fluorescent spot test. Definitive G6PD status was determined by genotyping. Day (D) 7 haemoglobin (Hb) concentration was the primary outcome measure. Results: One hundred nine patients (88 males, 21 females), aged 4-76 years (median 23) were enrolled; 12 were G6PDd Viangchan (9 hemizygous males, 3 heterozygous females). Mean nadir Hb occurred on D7 [11.6 (range 6.4 15.6) g/dL] and was significantly lower (p = 0.040) in G6PDd (n = 9) vs. G6PDn (n = 46) DHAPP+SLDPQ recipients: 10.9 vs. 12.05 g/dL, Δ = -1.15 (95% CI: -2.24 -0.05) g/dL. Three G6PDn patients had D7 Hb concentrations < 8 g/dL; D7-D0 Hbs were 6.4 6.9, 7.4 7.4, and 7.5 8.2 g/dL. For all patients, mean (range) D7-D0 Hb decline was -1.45 (-4.8 2.4) g/dL, associated significantly with higher D0 Hb, higher D0 parasitaemia, and receiving DHAPP; G6PDd was not a factor. No patient required a blood transfusion. Conclusions: DHAPP+SLDPQ was associated with modest Hb declines in G6PD Viangchan, a moderately severe variant. Our data augment growing evidence that SLDPQ in SE Asia is well tolerated and appears safe in G6PDd patients. Cambodia is now deploying SLDPQ and this should encourage other GMS countries to follow suit.
URI: http://repository.li.mahidol.ac.th/dspace/handle/123456789/51792
metadata.dc.identifier.url: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85063011999&origin=inward
ISSN: 14712334
Appears in Collections:Scopus 2019

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.