Vivax malaria: preliminary observations following a shorter course of treatment with artesunate plus primaquine

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene 2007-06, Vol.101 (6), p.534-539
• Main Authors: Dao, Nguyen Van Hoang, Cuong, Bui Tri, Ngoa, Nguyen Dang, Thuy, Le Thi Thanh, The, Nguyen Duy, Duy, Dinh Ngoc, Dai, Bui, Thanh, Nguyen Xuan, Chavchich, Marina, Rieckmann, Karl H., Edstein, Michael D.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adolescent; Adult; Animals; Antimalarials - administration & dosage; Antimalarials - therapeutic use; Artemisinins - administration & dosage; Artemisinins - therapeutic use; Artesunate; Biological and medical sciences; Chloroquine; Drug Therapy, Combination; Female; Human protozoal diseases; Humans; Infectious diseases; Malaria; Malaria, Vivax - blood; Malaria, Vivax - drug therapy; Male; Medical sciences; Parasitic diseases; Plasmodium vivax; Primaquine; Primaquine - administration & dosage; Primaquine - therapeutic use; Protozoal diseases; Secondary Prevention; Sesquiterpenes - administration & dosage; Sesquiterpenes - therapeutic use; Viet Nam
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1016/j.trstmh.2007.01.003

The standard adult treatment regimen for Plasmodium vivax malaria is chloroquine (1500 mg over 3 d) plus primaquine (15 or 30 mg daily for 14 d), but patient compliance tends to be poor with the lengthy course. Preliminary observations are reported on the efficacy of a shorter treatment course – artesunate (200 mg twice a day for 2 d) plus primaquine (22.5 mg base twice a day for 7 d) – given to 28 adult patients infected with P. vivax in Viet Nam. All patients responded quickly to treatment with mean (SD) parasite and fever clearance times of 14.2 (4.0) and 18.6 (8.4) h, respectively. The high dose of primaquine was generally well tolerated, and only one patient (3.6%) had a recurrence of parasitaemia during 28 d of follow-up. As most patients infected with Southeast Asian strains of P. vivax have their first relapse within 28 d after treatment with rapidly eliminated blood schizonticides, the absence of parasitaemia in the remaining 27 patients suggests that this drug regimen was active against both blood and liver stages. Further studies are needed to confirm that this rapidly acting, short artesunate–primaquine regimen can result in better patient compliance and treatment outcomes than the chloroquine–primaquine regimen.