title: Therapeutic efficacy of alternative primaquine regimens to standard treatment in preventing relapses by Plasmodium vivax: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare efficacy and safety of primaquine regimens currently used to prevent relapses by P. vivax.
  
  
  METHODS
  A systematic review was carried out to identify clinical trials evaluating efficacy and safety to prevent malaria recurrences by P. vivax of primaquine regimen 0.5 mg/kg/ day for 7 or 14 days compared to standard regimen of 0.25 mg/kg/day for 14 days. Efficacy of primaquine according to cumulative incidence of recurrences after 28 days was determined. The overall relative risk with fixed-effects meta-analysis was estimated.
  
  
  RESULTS
  For the regimen 0.5 mg/kg/day/7 days were identified 7 studies, which showed an incidence of recurrence between 0% and 20% with follow-up 60-210 days; only 4 studies comparing with the standard regimen 0.25 mg/kg/day/14 days and no difference in recurrences between both regimens (RR= 0.977, 95% CI= 0.670 to 1.423) were found. 3 clinical trials using regimen 0.5 mg/kg/day/14 days with an incidence of recurrences between 1.8% and 18.0% during 330-365 days were identified; only one study comparing with the standard regimen (RR= 0.846, 95% CI= 0.484 to 1.477). High risk of bias and differences in handling of included studies were found.
  
  
  CONCLUSIONS
  Available evidence is insufficient to determine whether currently PQ regimens used as alternative rather than standard treatment have better efficacy and safety in preventing relapse of P. vivax. Clinical trials are required to guide changes in treatment regimen of malaria vivax.
authors: Grupo Malaria, Facultad de Medicina. Universidad de Antioquia. Medellín, Colombia. ; Grupo Epidemiología y Bioestadística, Facultad de Medicina. Universidad CES. Medellín, Colombia Medellín.
authors: Lina Marcela
authors: LM
authors: Zuluaga-Idarraga
authors: Grupo Académico de Epidemiología Clínica, Facultad de Medicina. Universidad de Antioquia. Medellín, Colombia.; Departamento de Pediatría, Universidad de Antioquia, Fundación Hospital Universitario San Vicente, Medellín, Colombia.
authors: María-Eulalia
authors: ME
authors: Tamayo Perez
authors: Grupo Académico de Epidemiología Clínica, Facultad de Medicina. Universidad de Antioquia. Medellín, Colombia .
authors: Daniel Camilo
authors: DC
authors: Aguirre-Acevedo
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use; D000077332:Artesunate; D002738:Chloroquine / Q000627:therapeutic use; D004334:Drug Administration Schedule; D006801:Humans; D016780:Malaria, Vivax / Q000517:prevention & control*; D010966:Plasmodium vivax; D011319:Primaquine / Q000627:therapeutic use*; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods*
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate; D002738:Chloroquine; D011319:Primaquine
keywords: Malaria; Plasmodium vivax; pharmacovigilance; primaquine; recurrence