Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study

Townell, Nicola, Looke, David, McDougall, David and McCarthy, James S. (2012) Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study. Malaria Journal, 11 214.1-214.7. doi:10.1186/1475-2875-11-214

Author Townell, Nicola
Looke, David
McDougall, David
McCarthy, James S.
Title Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study
Journal name Malaria Journal   Check publisher's open access policy
ISSN 1475-2875
Publication date 2012-06
Sub-type Article (original research)
DOI 10.1186/1475-2875-11-214
Open Access Status DOI
Volume 11
Start page 214.1
End page 214.7
Total pages 7
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2013
Language eng
Formatted abstract
Background: Relapsing Plasmodium vivax infection results in significant morbidity for the individual and is a key factor in transmission. Primaquine remains the only licensed drug for prevention of relapse. To minimize relapse rates, treatment guidelines have recently been revised to recommend an increased primaquine dose, aiming to achieve a cumulative dose of ≥6 mg/kg, i.e. ≥420 mg in a 70 kg patient. The aims of this study were to characterize the epidemiology of P. vivax infection imported into Queensland Australia, to determine the rates of relapse, to investigate the use of primaquine therapy, and its efficacy in the prevention of relapse.
Methods: A retrospective study was undertaken of laboratory confirmed P. vivax infection presenting to the two major tertiary hospitals in Queensland, Australia between January 1999 and January 2011.
Primaquine dosing was classified as no dose, low dose (<420 mg), high dose (≥420 mg), or unknown. The dose of primaquine prescribed to patients who subsequently relapsed that prescribed to patients who did not relapse.
Results: Twenty relapses occurred following 151 primary episodes of P. vivax infection (13.2%). Relapses were confirmed among 3/21 (14.2%), 9/50 (18.0%), 1/54 (1.9%) and 7/18 (38.9%) of patients administered no dose, low dose, high dose and unknown primaquine dose respectively. High dose primaquine therapy was associated with a significantly lower rate of relapse compared to patients who were prescribed low dose therapy (OR 11.6, 95% CI 1.5-519, p = 0.005).
Conclusions: Relapse of P. vivax infection is more likely in patients who received low dose primaquine therapy. This study supports the recommendations that high dose primaquine therapy is necessary to minimize relapse of P. vivax malaria.
Keyword Plasmodium vivax
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article # 214

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
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