title: Optimal primaquine use for radical cure of Plasmodium vivax and Plasmodium ovale malaria in Japanese travelers--A retrospective analysis.
abstract: BACKGROUND
  Recently, a dose of 30 mg (base) primaquine daily for 14 days is increasingly recommended for radical cure of Plasmodium vivax malaria. However, total primaquine doses, or those per body weight, are also recognized as important. In Japan, primaquine is not a licensed medicine, but has been used through the Research Group on Chemotherapy of Tropical Diseases for >3 decades.
  
  
  METHODS
  Based on clinical records submitted to the Research Group, patients with P. vivax and Plasmodium ovale malaria treated with primaquine were analyzed to determine the efficacy and safety of the antimalarial drug.
  
  
  RESULTS
  Seventy-five P. vivax cases, including 3 in children, and 19 P. ovale cases were enrolled. Five of the P. vivax cases demonstrated at least one relapse despite primaquine therapy. Total primaquine doses per body weight were obtained in 4 of the 5 relapsed patients, presenting 9 malaria episodes totally, and most of the primaquine failures were caused with a total dose ≤ 3.5 mg/kg. Liver function disturbance was reported in 2 cases.
  
  
  CONCLUSIONS
  In order to optimize radical cure of P. vivax, the total primaquine dose per body weight should be considered, at least 3.5 mg/kg or even more if contracted in countries with significant drug resistance. Possibility of primaquine hepatotoxicity in chronic liver disease patients remains to be elucidated.
authors.affiliation: Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kikuchi
authors.affiliation: Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Koga
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsuoka
authors.affiliation: Department of Infectious Diseases, Division of Parasitology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Maruyama
authors.affiliation: Department of Internal Medicine, Shin-Yamanote Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan. Electronic address: kimumiki@shinyamanote.jp.
authors.forename: Mikio
authors.initials: M
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage*; D044466:Asian People; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007564:Japan; D008099:Liver / Q000187:drug effects; D008288:Malaria / Q000188:drug therapy*; D016780:Malaria, Vivax / Q000188:drug therapy* / Q000517:prevention & control; D008297:Male; D041122:Plasmodium ovale / Q000187:drug effects*; D010966:Plasmodium vivax / Q000187:drug effects*; D011319:Primaquine / Q000008:administration & dosage* / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D014195:Travel; D055815:Young Adult
chemical_list: D000962:Antimalarials; D011319:Primaquine
keywords: Efficacy; Japanese traveler; Plasmodium vivax/ovale; Primaquine; Safety