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Randomized Controlled Trial
. 2014 Jul;91(1):18-26.
doi: 10.4269/ajtmh.13-0053. Epub 2014 Apr 21.

Efficacy of three different regimens of primaquine for the prevention of relapses of Plasmodium vivax malaria in the Amazon Basin of Peru

Salomón Durand  1 , Cesar Cabezas  2 , Andres G Lescano  2 , Mariela Galvez  2 , Sonia Gutierrez  2 , Nancy Arrospide  2 , Carlos Alvarez  2 , Meddly L Santolalla  2 , David J Bacon  2 , Paul C F Graf  2
Affiliations
Randomized Controlled Trial

Efficacy of three different regimens of primaquine for the prevention of relapses of Plasmodium vivax malaria in the Amazon Basin of Peru

Salomón Durand et al. Am J Trop Med Hyg. 2014 Jul.

Abstract

We evaluated the efficacy of three primaquine (PQ) regimes to prevent relapses with Plasmodium vivax through an open-label randomized trial in Loreto, Peru. Vivax monoinfections were treated with chloroquine for 3 days and PQ in three different regimes: 0.5 mg/kg per day for 5 days (150 mg total), 0.5 mg/kg per day for 7 days (210 mg total), or 0.25 mg/kg per day for 14 days (210 mg total). Biweekly fever assessments and bimonthly thick smears were taken for 210 days. Recurrences after 35 days were considered relapses. One hundred eighty cases were enrolled in each group; 90% of cases completed follow-up. There were no group-related differences in age, sex, or parasitemia. Relapse rates were similar in the 7- and 14-day regimes (16/156 = 10.3% and 22/162 = 13.6%, P = 0.361) and higher in the 5-day group (48/169 = 28.4%, P < 0.001 and P = 0.001, respectively). The 7-day PQ regimen used in Peru is as efficacious as the recommended 14-day regimen and superior to 5 treatment days.

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Figures

Figure 1.
Figure 1.
Study sites in the Peruvian Amazon region.
Figure 2.
Figure 2.
Malaria cases and causes of exclusion.
Figure 3.
Figure 3.
Cumulative fraction of P. vivax infections that had not relapsed after treatment with three different regimens of PQ.
Figure 4.
Figure 4.
Instantaneous risk of relapse (smoothed hazard) in P. vivax infections treated with three different regimens of PQ.
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