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We studied prospectively 801 Thai patients admitted to the Bangkok Hospital for Tropical Diseases with acute, symptomatic Plasmodium vivax malaria to determine the optimum duration of treatment with oral artesunate and the safety, tolerability, and effectiveness of a high dose of primaquine in prevention of relapse. Patients were randomly assigned to one of four treatment groups: 1) a five-day course of artesunate (Group A5); 2) a seven-day course of artesunate (Group A7); 3) a five-day course of artesunate plus a 14-day course of high-dose primaquine (0.6 mg/kg, maximum dose = 30 mg) (Group A5 + P); and 4) a seven-day course of artesunate plus a 14-day course of high-dose primaquine (Group A7 + P). During 28 days of observation, P. vivax reappeared in the blood of 50% of those who received artesunate alone (Groups A5 and A7), compared with none of those who received primaquine (Groups A5 + P and A7 + P; P < 0.0001). Adverse effects were confined to the 13 patients with a deficiency for glucose-6-phosphate dehydrogenase; high-dose primaquine (0.6 mg/kg of base a day) had to be stopped in four (31%) patients because of a significant decrease in the hematocrit. The combination of five days of artesunate and 14 days of primaquine is a highly effective and generally well-tolerated treatment regimen for vivax malaria in Thailand.
Received January 2, 2003. Accepted for publication March 10, 2003.
Acknowledgments: We are grateful to the staff of the Hospital for Tropical Diseases for their help and support. Nicholas J. White is a Wellcome Trust Principal Fellow.
Financial support: This study was supported by the Thailand-Tropical Diseases Research Programme (T2), Department of Medical Science, Ministry of Public Health, Thailand, National Institutes of Health grant R01 AI-51310, and the Tak Malaria Initiative supported by the Bill and Melinda Gates Foundation.
Authors’ addresses: Udomsak Silachamroon, Sombat Treeprasertsuk, Polrat Wilairatana, Kobsiri Chalearmrult, Hla Yin Mint, Pannamas Maneekan, and Sornchai Looareesuwan, Department of Clinical Tropical Medicine and Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand, Telephone: 66-2-247-1688, Fax: 66-2-245-7288, E-mail: tmslr{at}mahidol.ac.th. Srivicha Krudsood, Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand. Nicholas J. White, Wellcome Trust Mahidol University Oxford Tropical Medicine Research Programme Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand. Victor R. Gourdeuk, Center for Sickle Cell Disease, Howard University, 2121 Georgia Avenue, NW, Washington, DC 20059. Gary M. Brittenham, College of Physicians and Surgeons, Columbia University, Harkness Pavilion, Room HP568, 630 West 168th Street, New York, NY 10032-3795.
Reprint requests: Prof. S. Looareesuwan, E-mail: tmslr{at}mahidol.ac.th.
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