Consideration of ethics in primaquine therapy against malaria transmission

Millions of people receive primaquine against sexual plasmodia responsible for malaria transmission. These gametocytes cause no symptoms and do not threaten the host, but they infect mosquitoes and threaten the community. Primaquine causes hemolysis in the small minority of patients with glucose-6-p...

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Bibliographic Details
Published in:Trends in parasitology 2011-01, Vol.27 (1), p.11-16
Main Authors: Baird, J. Kevin, Surjadjaja, Claudia
Format: Article
Language:English
Subjects:
Antimalarials - adverse effects
Antimalarials - therapeutic use
Biological and medical sciences
clinical trials
Culicidae
Erythrocytes - drug effects
Erythrocytes - enzymology
Erythrocytes - parasitology
ethics
gametocytes
Gastroenterology and Hepatology
General aspects
glucose-6-phosphate 1-dehydrogenase
Glucosephosphate Dehydrogenase - blood
Glucosephosphate Dehydrogenase Deficiency - drug therapy
Glucosephosphate Dehydrogenase Deficiency - enzymology
Glucosephosphate Dehydrogenase Deficiency - parasitology
hemolysis
Human protozoal diseases
Humans
Infectious Disease
Infectious diseases
Malaria
Malaria - drug therapy
Malaria - enzymology
Malaria - transmission
Medical sciences
Parasitic diseases
parasitology
patients
people
Primaquine - adverse effects
Primaquine - therapeutic use
Protozoal diseases
risk
safety assessment
screening
Sexually Transmitted Diseases - drug therapy
Sexually Transmitted Diseases - enzymology
Sexually Transmitted Diseases - parasitology
therapeutics
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Summary:Millions of people receive primaquine against sexual plasmodia responsible for malaria transmission. These gametocytes cause no symptoms and do not threaten the host, but they infect mosquitoes and threaten the community. Primaquine causes hemolysis in the small minority of patients with glucose-6-phosphate dehydrogenase deficiency (G6PDd). Clinical studies in the 1950s demonstrated gametocytocidal primaquine to be safe without G6PDd screening. However, the evaluated G6PDd variant, African A-, represents mild sensitivity to primaquine. The view of primaquine as a safe gametocytocide thus rests largely upon observations from a G6PDd variant that is unlikely to challenge safety. The early clinical work does not seem to afford an adequate assessment of safety in G6PDd patients. Potential risk of harm without clinical benefit to the patient raises ethical questions that should be examined.
ISSN:1471-4922
1471-5007
DOI:10.1016/j.pt.2010.08.005