Primaquine at alternative dosing schedules for preventing relapse in people with Plasmodium vivax malaria.

摘要: Background: Malaria caused by Plasmodium vivax requires treatment of the blood-stage infection and hypnozoites that develop in liver. This is a challenge to effective case management P malaria, as well being more general substantial impediment malaria control. The World Health Organization (WHO) recommends 14-day drug course with primaquine, an 8-aminoquinoline, at 0.25 mg/kg/day most world (standard course), or 0.5 East Asia Oceania (high-standard course). long can be difficult complete, primaquine cause dangerous haemolysis individuals glucose-6-phosphate dehydrogenase (G6PD) deficiency, meaning physicians may reluctant prescribe areas where G6PD testing not available. Cochrane Review evaluated whether patient-friendly alternative regimens are efficacious standard regimen for radical cure ofP malaria. Objectives: To assess efficacy safety compared high-standard 14 days (0.25 mg/kg/day), comparison these two WHO-recommended regimens. Search methods: We searched Infectious Diseases Group (CIDG) Specialized Register; Central Register Controlled Trials (CENTRAL); MEDLINE (PubMed); Embase (Ovid); LILACS (BIREME) up 17 December 2018. also WHO International Clinical Registry Platform (ICTRP) ClinicalTrials.gov, checked reference lists all studies identified above methods. Selection criteria: Randomized controlled trials (RCTs) adults children using any either chloroquine artemisinin-based combination therapy (ACT) plus higher daily doses days, shorter same total dose, weekly dosing regimens; usual recommended days), Data collection: analysis Two review authors independently assessed trial eligibility quality, extracted data. calculated risk ratios (RRs) 95% confidence intervals (CIs) dichotomous grouped data according length follow-up. analysed this information was included. Main results High-standard versus course: RCTs regimen. People deficiency pregnant lactating women were excluded. do know if there difference recurrences 6 months (with chloroquine: RR 0.82, CI 0.47 1.43, 639 participants, very low-certainty evidence; ACT: 1.11, 0.17 7.09, 38 evidence). No serious adverse events reported. dosage (very 0.5 7 Five course. There little no when dose (0.5 210 mg) over (RR 0.96, 0.66 1.39; 1211 participants; number known occur between longer 1.06, 0.64 1.76; 1154 frequency anaemia discontinuation groups Three excluded people did provide information. Pregnant details provided regarding their inclusion exclusion. 0.75 mg/kg primaquine/week 8 weeks One RCT G6PD-deficient patients randomized but included group. Only one participant detected during trial. increases decreases 11 months’ follow-up 3.18, 0.37 27.6; 122 episodes other different have results available, used been widely evidence low certainty. Authors’ conclusions: Although limited detect recurrence 7-day reported G6PD-normal participants taking primaquine. useful adherence concerns. Further large high-quality needed, such IMPROV trial, standardised help resolve uncertainties.