title: Therapeutic Assessment of Primaquine for Radical Cure ofPlasmodium vivaxMalaria at Primary and Tertiary Care Centres in Southwestern India.
abstract: Acquaintance is scanty on primaquine (PQ) efficacy andPlasmodium vivaxrecurrence in Udupi district, Karnataka, India. We assessed the efficacy of 14 days PQ regimen (0.25 mg/kg/day) to preventP. vivaxrecurrence. Microscopically, aparasitemic adults (≥18 years) after acute vivax malaria on day 28 were re-enrolled into 15 months' long follow-up study. A peripheral blood smear examination was performed with participants at every 1-2 month interval. A nested PCR test was performed to confirm the mono-infection withP. vivax. Of 114 participants, 28 (24.6%) recurred subsequently. The median (IQR) duration of the first recurrence was 3.1 (2.2-5.8) months which ranged from 1.2 to 15.1 months, including initial 28 days. Participants with history of vivax malaria had significantly higher risk of recurrence, with hazard ratio (HR) (95% CI) of 2.62 (1.24-5.54) (P=0.012). Severity of disease (11.4%, 13/114) was not associated (P=1.00) with recurrence. Of 28 recurrence cases, the nPCR proved thatP. vivaxmono-infection recurrence rate was at least 72.7% (16/22) at first recurrence. In Udupi district, PQ dose of 0.25 mg/kg/day over 14 days seems inadequate to prevent recurrence in substantial proportion of vivax malaria. Patients with a history of vivax malaria are at high risk of recurrences.
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, Karnataka, 576104, India.
authors.forename: Rishikesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Statistics, Manipal University, Madhav Nagar, Manipal, Karnataka, 576104, India.
authors.forename: Vasudeva
authors.initials: V
authors.lastname: Guddattu
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, Karnataka, 576104, India.|Manipal McGill Center for Infectious Diseases, Manipal University, Madhav Nagar, Manipal, Karnataka, 576104, India.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Saravu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D016780:Malaria, Vivax / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011319:Primaquine / Q000008:administration & dosage*; D011320:Primary Health Care; D055502:Secondary Prevention / Q000379:methods*; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000962:Antimalarials; D011319:Primaquine
keywords: Plasmodium vivax; anti-malarial; malaria; primaquine; relapse; treatment failure