Abstract
BackgroundThe preventive treatment of Plasmodium vivax relapse recommended by the World Health Organization is primaquine at a dose of 15 mg/day for 14 days, except for malaria cases from Asia and Oceania. Since 2006, CDC recommends the use of primaquine at 30 mg/day for 14 days. In France, all cases of malaria due to P. vivax are treated with 30 mg of primaquine. This systematically increased dosage needs to be evaluated according to epidemiological context. The aim of the study was to compare relapses after 14 days of primaquine at 15 or 30 mg/day.MethodsAll patients treated with primaquine after a vivax malaria episode in French Guiana, between 1 January, 2007 and 1 August, 2016, were studied. Based on the compulsory hospital pharmacy forms for primaquine delivery, adult patients who received 15 or 30 mg of primaquine during 14 days for hypnozoite eradication were included. The recommended dose was initially 15 mg and was changed to 30 mg in 2011. Vivax malaria recurrences within 2 months after primaquine treatment, and vivax malaria recurrences 2–6 months after primaquine in each treatment group were analysed using survival analysis at 2, 3 and 6 months.ResultsOut of 544 patients included, 283 received 15 mg/day and 261 received 30 mg/day of primaquine. At 2 and 3 months after primaquine treatment, the number of recurrences was 7 (2.5%) and 19 (7.3%), and 9 (3.4%) and 15 (5.3%), in the 15 and 30 mg groups (p = 0.51 respectively 0.35), respectively. Within 3 months, the median time to recurrence was 2.05 months in the 15 and 30 mg groups. At 6 months after primaquine treatment, the number of recurrences was 25 (8.8%) and 31 (11.9%) at 15 and 30 mg, respectively (p = 0.24). The median time to recurrence was 2.38 months at 15 mg/day and of 2.64 months at 30 mg/day.ConclusionsThere were no significant differences between primaquine at 15 or 30 mg/day for 14 days in the prevention of P. vivax relapses at 2, 3 and 6 months after primaquine treatment in French Guiana.
Highlights
The preventive treatment of Plasmodium vivax relapse recommended by the World Health Organiza‐ tion is primaquine at a dose of 15 mg/day for 14 days, except for malaria cases from Asia and Oceania
The proportion of malaria cases caused by P. vivax increased from 54 to 70% between 2005 and 2011 [5, 6]
Patients were excluded if they were under 18 years old, had no initial microscopic diagnosis, if they had mixed infections with P. falciparum, had a relapse before initiating primaquine or received a different primaquine regimen
Summary
The preventive treatment of Plasmodium vivax relapse recommended by the World Health Organiza‐ tion is primaquine at a dose of 15 mg/day for 14 days, except for malaria cases from Asia and Oceania. The predominant species responsible of malaria in French Guiana is Plasmodium vivax [1]. Much of the malaria burden is not detected by the information system because it affects illegal gold miners living deep in the Amazon forest [2– 4]. Despite this major reservoir, in the villages of French Guiana, incidence progressively decreased from around 2.5% in the early 2000s to 0.5% in 2011 and even 0.1% in 2016. On the Guiana shield, in 2016, Guyana, Suriname and French Guiana reported 10,906 cases, 315 cases and 173 cases, respectively [7]
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