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Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study.
Malar J 2012; 11:214MJ

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.

Authors+Show Affiliations

Queensland Institute of Medical Research, University of Queensland, Queensland, Australia.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22727113

Citation

Townell, Nicola, et al. "Relapse of Imported Plasmodium Vivax Malaria Is Related to Primaquine Dose: a Retrospective Study." Malaria Journal, vol. 11, 2012, p. 214.
Townell N, Looke D, McDougall D, et al. Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study. Malar J. 2012;11:214.
Townell, N., Looke, D., McDougall, D., & McCarthy, J. S. (2012). Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study. Malaria Journal, 11, p. 214. doi:10.1186/1475-2875-11-214.
Townell N, et al. Relapse of Imported Plasmodium Vivax Malaria Is Related to Primaquine Dose: a Retrospective Study. Malar J. 2012 Jun 22;11:214. PubMed PMID: 22727113.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study. AU - Townell,Nicola, AU - Looke,David, AU - McDougall,David, AU - McCarthy,James S, Y1 - 2012/06/22/ PY - 2012/02/28/received PY - 2012/06/06/accepted PY - 2012/6/26/entrez PY - 2012/6/26/pubmed PY - 2013/3/7/medline SP - 214 EP - 214 JF - Malaria journal JO - Malar. J. VL - 11 N2 - 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. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/22727113/full_citation L2 - https://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-11-214 DB - PRIME DP - Unbound Medicine ER -