Primaquine is active as a chloroquineresistance reverser at concentrations that could be clinically relevant. Side effects of chloroquine and primaquine and symptom. It has insignificant activity against the asexual blood forms of the parasite and therefore it is always used in conjunction with a blood schizonticide and never as a single agent. It is the only drug proven to be effective, and licensed to eliminate, the. Uncomplicated falciparum malaria consists of symptomatic plasmodium falciparum infection with a positive parasitologic test and parasitemia in the absence of symptoms consistent with severe malaria. The us army developed primaquine for soldiers in a wartime. Primaquine is an 8aminoquinoline anti protozoal agent which is highly active against exo. Primaquine is now used for prophylaxis, radical cure of vivax and ovale malaria, and as a singledose gametocytocide 050075 mg base per kg to treat falciparum malaria.
Primaquine to prevent transmission of falciparum malaria nicholas j white falciparum malaria is transmitted by anopheline mosquitoes that have fed on blood containing gametocytes of plasmodium falciparum. Policy brief on singledose primaquine as a gametocytocide in. Primaquine for reducing plasmodium falciparum transmission. Comparison of gametocyte carriage in patients with falciparum malaria who did or did not receive primaquine in a comparison of di. Primaquine becomes increasingly important as malaria endemic countries move towards elimination, and although it is widely recommended, it is commonly not given to malaria patients. Chloroquine versus dihydroartemisininpiperaquine with standard highdose primaquine given either for 7 days or 14 days in plasmodium vivax. Therefore, if primaquine is not used in falciparum malaria, there will be a selective spread of p. Review of primaquine to prevent malaria transmission. Single lowdose primaquine for blocking transmission of. The study involved investigation of not only pq, but several analogues as well. Dec 12, 2011 the current uses of primaquine in vivax malaria are threefold. Six decades after its official licensing, primaquine still holds a unique and unchallenged place in antimalarial regimens of cure and prophylaxis. Our gp uses a prick of blood and examines under a microscope.
Optimal dose and timing of primaquine administration for. In 2012, the world health organization who recommended a single dose of 0. Therefore, those servicemen stationed in an area where falciparum malaria is endemic take a daily dose of dapsone, 25 mg, in addition to the chloroquineprimaquine pill. Mefloquine is a useful alternative treatment for p. When added to an act, singledose primaquine rapidly kills mature gametocytes and, therefore, substantially lowers the risk of transmission figure 1. Three developed falciparum malaria two to three weeks after leaving the endemic area, although one of them had taken doxycycline alone. Plasmodium falciparum cdc stacks centers for disease control.
Jan 18, 2018 in 2012, the world health organization recommended blocking the transmission of plasmodium falciparum with single lowdose primaquine sldpq, target dose 0. Primaquine potentially has a major role in reducing malaria transmission. Primaquine is efficacious when supervised in clinical trials, but its effectiveness in realworld settings is unknown. Myself, my wife and my 2 kids both under 4 years old, get diagnosed with malaria approximately 34 times a year, usually vivax or falciparum. Falciparum is the most severe kind of malaria and may result in death if left untreated. The likely vector, anopheles gambiae mosquitoes, had not been detected in algeria. The optimum timing of primaquine administration to treat falciparum malaria is unclear. This study presents new evidence that primaquine 5,6orthoquinone, the metabolite of primaquine reflecting the oxidative biotransformation pathway, is generated in erythrocytes, probably by nonenzymatic means, and may not require transport from the liver or other tissues. Lowdose primaquine to reduce the transmission of p. It is responsible for around 50% of all malaria cases. Oct 15, 2018 but it is required to prevent the spread of falciparum infection because unlike in case of p.
Singledose primaquine as gametocytocidal treatment in patients with uncomplicated falciparum malaria. Sep 22, 2014 in march 2012, a group of experts from academia, industry, nongovernmental organizations, malaria programs, and funders convened to discuss existing data on the use of primaquine as a malaria transmission blocker. Red blood cells that are infected with the parasite tend to sludge and lead to microinfarctions tiny areas of dead tissue due to lack of oxygen in capillaries in the brain, liver. Mefloquine is highly efficacious against chloroquine. Effect of primaquine on gametocyte development and clearance in. Unsupervised primaquine for the treatment of plasmodium.
Between the months of aprilseptember in both 2012 and 20, average. Primaquine is the only available drug to treat plasmodium vivax liver stages hypnozoites. Primaquine, an 8aminoquinoline, has been approved for treatment of malaria since 1952 by the food and drug administration fda, united states. A single dose of 025 mgkg primaquine, given alongside dihydroartemisininpiperaquine, was safe and efficacious for the prevention of p falciparum malaria transmission in boys and men who are not deficient in g6pd. The rapid sterilizing effect of primaquine in falciparum malaria.
Adding primaquine to the standard treatment of uncomplicated. Primaquine, 8aminoquinoline, plasmodium falciparum, africa. Primaquine to reduce transmission of plasmodium falciparum. The parasite is transmitted through the bite of a female anopheles mosquito and causes the diseases most dangerous form, falciparum malaria. In 2012, the world health organization recommended blocking the transmission ofplasmodium falciparum with single lowdose primaquine sldpq, target dose 0. The 8aminoquinoline 8aq drugs act on plasmodium falciparum gametocytes, which transmit malaria from infected people to mosquitoes. Pdf primaquine or other 8aminoquinolines for reducing. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020.
Primaquine potentially has a major role in reducing malaria transmission, especially in efforts to eliminate plasmodium falciparum malaria. Pdf effectiveness of doxycycline combined with primaquine for. For chloroquineresistant vivax malaria, amodiaquine 30 mg basekg bw divided over 3 days as 10 mgkg bw single daily doses combined with primaquine should be given. Peak plasma concentration occurs about 1 to 3 hours after a dose is taken and then rapidly. Single low doses of primaquine, when added to artemisininbased combination therapy, might prevent transmission of plasmodium falciparum malaria to mosquitoes. Primaquine belongs to a group of medicines, called antiprotozoals. Primaquine has gametocytocidal activity against all plasmodia, including p. Falciparum malaria is responsible for the majority of these deaths. The most dangerous type of malaria, which is caused by the parasite plasmodium falciparum. Rationale for recommending a lower dose of primaquine as a.
Falciparum malaria is associated with high levels of parasites in the blood and has the highest death rate and rate of complications of all types of malaria. Largescale artemisininpiperaquine mass drug administration. Despite its potential role in malaria control and elimination, the widespread adoption of primaquine has been slow due to its ability to induce hemolysis in g6pddeficient individuals. It was observed that while primaquine alone could terminate an acute attack of p. Hoffman 1us naval medical research center detachment, lima, peru, and 2sanaria, rockville, maryland primaquine is the only available drug for preventing relapse of malaria, and confusion surrounds its use. In 2012 the world health organization who revised its recommendation for a single dose of pq alongside treatment for p. Uncomplicated falciparum malaria consists of symptomatic plasmodium falciparum infection with a positive parasitologic test and parasitemia 2012. Medicines for the prevention of malaria while traveling. It is an alternative treatment for pneumocystis pneumonia together with clindamycin. Primaquine is a medication used to treat and prevent malaria and to treat pneumocystis pneumonia. Ethics, economics, and the use of primaquine to reduce. Primaquine is the only drug that can be used to eliminate hypnozoites, the dormant forms of the malaria parasites. Plasmodium falciparum centers for disease control and. Relapse of imported plasmodium vivax malaria is related to primaquine dose.
A single dose of primaquine added to malaria treatment to. This agent eliminates tissue exoerythrocytic malarial infection, preventing the development of the erythrocytic forms of the parasite which are responsible for relapses in plasmodium vivax and ovale. Where act has been adopted as the firstline treatment for p. Although its mechanism of action is unclear, primaquine bind to and alter the properties of protozoal dna. Genes for resistance to chloroquine were detected in the parasite. Primaquine to reduce transmission of plasmodium falciparum malaria in mali. Fortyone indians suffering from overt malarial attacks 4 p. Reinventing primaquine for endemic malaria jk baird eijkmanoxford clinical research unit, jalan diponegoro no. Single dose primaquine as a gametocytocide in plasmodium falciparum malaria, who global malaria programme, updated who policy recommendation, oct 2012. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. They should take one dose per day while there, and for. Primaquine is available only with your doctors prescription.
When taking primaquine for the prevention of malaria. Find patient medical information for primaquine oral on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. A major change in recent years has been the recognition that severe malaria, predominantly caused by plasmodium falciparum, is a complex multisystem disorder presenting with a range of clinical. Primaquine is not used in the prevention of malaria, only in the treatment. Male or female patients between the age of 6 months and 60 years and with a minimum of 5kg bodyweight. It is the only drug proven to be effective, and licensed to eliminate, the hypnozoites of. Patients were evaluated for the presence of 21 symptoms before and after treatment and for reported side effects of these drugs after treatment was started. Previous public health interventions, such as the smallpox and polio eradication campaigns, posed comparable risks to vaccinated individuals, as does the use of sulfadoxinepyrimethamine and other antimalarials in intermittent preventive treatment often provided to children and pregnant women in malariaendemic. Recommended only for the radical cure of vivax malaria, the prevention of relapse in vivax malaria, or after the end of chloroquine phosphate suppressive therapy in vivax malaria endemic area. Pdf relapse of imported plasmodium vivax malaria is related. May 23, 2019 primaquine belongs to a group of medicines, called antiprotozoals.
Mefloquine cure rates were far superior 96% against p. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and pfk. In areas of low malaria transmission, where symptomatic infections contribute substantially to malaria transmission, the use of. If diagnosis and proper treatment are delayed, falciparum malaria can kill the patient very quickly.
Phase 2a dose escalation study of the efficacy, safety and pharmacokinetics of low singledose primaquine for gametocytocidal activity against p. In volunteer studies, where primaquine was given alone, it provided a rapid and protracted sterilising effect and suppression of gametocytaemia in acute falciparum malaria, without changes in asexual parasite densities. Primaquine dose escalation study malaria elimination initiative. Primaquine is the only available antimalarial drug that kills dormant liver. We aimed to establish the activity and safety of four low doses of primaquine combined with dihydroartemisininpiperaquine in male patients in mali. Use of primaquine and glucose6phosphate dehydrogenase. In addition, it is used as a gametocytocidal agent in falciparum malaria.
The outbreak shows the potential for an increase in malaria vectors in algeria. Lowdose primaquine for falciparum malaria request pdf. The three less common and less dangerous plasmodium species are. The population benefits of reducing malaria transmission by gametocytocidal drugs require that a very high proportion of patients receive these medicines. A recent publication has shown that primaquine, a drug used to clear liverstage plasmodium vivax infection, acts as a chloroquineresistance reversing agent for plasmodium falciparum in culture. Once infection occurs, older travelers have a higher risk of poor clinical outcomes and death.
For chloroquineresistant vivax malaria, amodiaquine 30 mg basekg bw divided over 3 days as 10 mgkg bw single daily doses combined with primaquine should be given where act has been adopted as the firstline treatment for p. Primaquine is readily absorbed from the gastrointestinal tract and extensively distributed into body tissues. An outbreak of plasmodium falciparum malaria occurred in tinzaouatine in southern algeria in 2007. As the only marketed drug that is capable of clearing mature p. Unsupervised primaquine for the treatment of plasmodium vivax. Plasmodium falciparum is a unicellular protozoan parasite of humans, and the deadliest species of plasmodium that causes malaria in humans. Plasmodium falciparum is the plasmodium species responsible for 85 % of the malaria cases. In 2012, the world health organization recommended blocking the transmission of plasmodium falciparum with single lowdose primaquine sldpq, target dose 0. Mass drug administration mda, with or without lowdose primaquine. The case fatality rate increased dramatically with age. Side effects of antimalarial drug can overlap with malaria symptoms. Observe patient for tolerance if primaquine phosphate is prescribed for an individual who has shown a previous idiosyncrasy to primaquine phosphate as manifested by hemolytic anemia, methemoglobinemia, or leukopenia, an individual with a family or personal history of favism, or an individual with erythrocytic glucose6phosphate dehydrogenase.
It works by treating malaria, a red blood cell infection transmitted by the bite of a mosquito. Primaquine to prevent transmission of falciparum malaria. Future studies should assess the safety of singledose primaquine in g6pddeficient individuals to define the therapeutic range of primaquine to enable the safe. In march 2012, a group of experts from academia, industry, nongovernmental organizations, malaria programs, and funders convened to discuss existing data on the use of primaquine as a malaria transmission blocker. Single dose primaquine for clearance of plasmodium falciparum. Often primaquine is not prescribed for falciparum malaria because it is not needed for attaining a cure of the infection. Primaquine is the only generally available antimalarial that prevents relapse in vivax and ovale malaria, and the only potent gametocytocide in falciparum malaria. Single dose primaquine as a gametocytocide in plasmodium.
Primaquine becomes increasingly important as malaria endemic countries move towards elimination, and although it is widely recommended, it is commonly not given to malaria patients because of haemolytic toxicity in subjects who are. As a consequence some countries deploy single dose primaquine as a gametocytocide, and some do. It is a vital component of global malaria elimination efforts. Oct 26, 2011 primaquine is the only drug that can be used to eliminate hypnozoites, the dormant forms of the malaria parasites. Primaquine is also highly active against gametocytes of plasmodia, especially plasmodium falciparum. Primaquine for preventing relapses in people with plasmodium vivax malaria gawrie nl galappaththy1, aika aa omari2, prathap tharyan3 1anti malaria campaign, ministry of health, dehiwala, sri lanka. Epidemiology and risk to the traveler sciencedirect. Primaquine is the only licensed drug for eradicating plasmodium vivax hypnozoites and, therefore, preventing relapses of vivax malaria. Since no vaccine is available for falciparum malaria, optimum protection for soldiers involves the combined use of these measures. Pdf relapse of imported plasmodium vivax malaria is.