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Primaquine in vivax malaria: an update and review on management issues

DOI: 10.1186/1475-2875-10-351

Keywords: Primaquine, Plasmodium vivax, Vivax Malaria, Prophylaxis, Radical cure

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Primaquine, an 8-aminoquinoline, has been approved for treatment of malaria since 1952 by the Food and Drug Administration (FDA), United States [1]. Six decades after its official licensing, primaquine still holds a unique and unchallenged place in anti-malarial regimens of cure and prophylaxis [2]. It is the only drug proven to be effective, and licensed to eliminate, the hypnozoites of Plasmodium vivax and Plasmodium ovale. Though primaquine is effective, unique and irreplaceable, it is also associated with serious hazards and side effects, such as its ability to precipitate haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals [3]. This prohibits its use in key groups, such as pregnant women [4]. The current uses of primaquine in vivax malaria are threefold: for radical cure of patients with confirmed parasitaemia; for causal prophylaxis; and for terminal prophylaxis [1]. In addition, it is used as a gametocytocidal agent in falciparum malaria.This update and review deals with the current role of primaquine in treatment of vivax malaria. It will explore this topic on several fronts namely: a) evidence of efficacy of primaquine for its current indications; b) potential hazards of its widespread use c) critical analysis of reported resistance against primaquine containing regimens d) evidence for combining primaquine with artemisinins in areas of chloroquine resistance and e) the potential for replacement of primaquine with newer drugs.A MEDLINE search was performed for all articles with the key word 'primaquine' and 'Vivax' in any field. The search was restricted to articles published in all languages within the last two decades (1991-2011). There were 480 abstracts in the original search with these restrictions. The software Endnote X3 (Thomson Reuters, Carlsbad, CA 92011, USA) was used to filter articles. Bibliographies of cited literature were also searched. All abstracts were read independently by the three authors, and key articles were


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