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Chloroquine versus dihydroartemisinin-piperaquine with standard high-dose primaquine given either for 7 days or 14 days in plasmodium vivax malaria

Issued Date

2019-04-08

Resource Type

Article

ISSN

15376591
10584838

DOI

10.1093/cid/ciy735

Other identifier(s)

2-s2.0-85064133909

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Mahidol University

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SCOPUS

Bibliographic Citation

Clinical Infectious Diseases. Vol.68, No.8 (2019), 1311-1319

Suggested Citation

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 Chloroquine versus dihydroartemisinin-piperaquine with standard high-dose primaquine given either for 7 days or 14 days in plasmodium vivax malaria. Clinical Infectious Diseases. Vol.68, No.8 (2019), 1311-1319. doi:10.1093/cid/ciy735 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/51727

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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

Author(s)

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

Other Contributor(s)

Mahidol University
 Nuffield Department of Clinical Medicine
 Mahidol-Oxford Tropical Medicine Research Unit (MORU)

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.

Keyword(s)

Medicine

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https://repository.li.mahidol.ac.th/handle/123456789/51727

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Scopus 2019