Towards adding primaquine to ACT treatment

The combined gametocidal effect of primaquine plus artemisinin-combination therapy (ACT) to reduce post-treatment transmission of P. falciparum malaria is a key operational research question for malaria treatment (previously discussed here). And the evidence of adding primaquine, particularly in areas of low to medium transmission, keeps piling up. Smithius et al. report results from a massive 5-arm study along the Thai-Myanmar border. The take home message: adding primaquine to any of the ACTs reduced gametocyte carriage by about 12 times relative to ACT alone. The absolute reduction will vary according to the number of patients initially presenting with gametocytes – which is site specific because of differences in transmission and health seeking practices or access. A key strength of the trial design was the inclusion of anemic patients and those with G6PD, who may be at risk for hemolysis from exposure to primaquine,  to reflect the population served by control programs. No serious adverse effects were reported but increases in hemoglobin within the two month follow-up period were slightly less (0.3 g/dL) among patients receiving primaquine.

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