Volume 69, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


We studied prospectively 801 Thai patients admitted to the Bangkok Hospital for Tropical Diseases with acute, symptomatic 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, 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; < 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.


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  1. Chareonviriyaphap T, Bangs MJ, Ratanatham S, 2000. Status of malaria in Thailand. Southeast Asian J Trop Med Public Health 31 : 225–237. [Google Scholar]
  2. Luxemburger C, Kyaw Ley Thew, White NJ, Webster HK, Kyle DE, Maelankiri L, Chongsuphajaisiddhi T, Nosten F, 1996. The epidemiology of malaria in a Karen population on the western border of Thailand. Trans R Soc Trop Med Hyg 90 : 105–111. [Google Scholar]
  3. Brockman A, Price RN, van Vugt M, Heppner DG, Walsh D, Sookto P, Wimonwattrawatee T, Looareesuwan S, White NJ, Nosten F, 2000. Plasmodium falciparum antimalarial drug susceptibility on the north-western border of Thailand during five years of extensive use of artesunate-mefloquine. Trans R Soc Trop Med Hyg 94 : 537–544. [Google Scholar]
  4. Looareesuwan S, Olliaro P, White NJ, Chongsuphajaisiddhi T, Sabcharoen A, Thimasarn K, Nosten F, Singhasivanon P, Supavej S, Khusmith S, Wyling S, Kanyok T, Walsh D, Leggat PA, Doberstyn EB, 1998. Consensus recommendation on the treatment of malaria in Southeast Asia. Southeast Asian J Trop Med Public Health 29 : 355–360. [Google Scholar]
  5. Tanariya P, Na-Bangchang K, Tin T, Limpaibul L, Brockelman CR, Karbwang J, 1995. Clinical response and susceptibility in vitro of Plasmodium vivax to the standard regimen of chloroquine in Thailand. Trans R Soc Trop Med Hyg 89 : 426–429. [Google Scholar]
  6. Marlar-Tan, Myat-Phone-Kyaw, Aye-Yu-Soe, Khaing-Khaing-Gyi, Ma-Sabai, Myint-Oo, 1995. Development of resistance to chloroquine by Plasmodium vivax in Myanmar. Trans R Soc Trop Med Hyg 89 : 307–308. [Google Scholar]
  7. Baird JK, Waidy I, Fryauff DJ, Sutanihardja MA, Leksnan B, Widjaya H, Kysdarmanto, Subianto B, 1997. In vivo resistance to chloroquine by Plasmodium vivax and Plasmodium falciparum at Nibire, Irian Jaya, Indonesia. Am J Trop Med Hyg 56 : 627–631. [Google Scholar]
  8. Looareesuwan S, Wilairatana P, Glanarongran R, Indravijit KA, Supeeranontha L, Chinnapha S, Scott TR, Chulay JD, 1999. Atovaquone and proguanil hydrochloride followed by primaquine for treatment of Plasmodium vivax malaria in Thailand. Trans R Soc Trop Med Hyg 93 : 637–640. [Google Scholar]
  9. Looareesuwan S, Buchachart K, Wilairatana P, Chalermrut K, Rattanapong Y, Amradee S, Siripipat S, Chullawichit S, Thimasan K, Ittiverakul M, Triampon A, Walsh DS, 1997. Primaquine-tolerant vivax malaria in Thailand. Ann Trop Med Parasitol 91 : 939–943. [Google Scholar]
  10. Luxemburger C, Nosten F, Kyle DE, Kiricharoen L, Chongsuphajaisiddhi T, White NJ, 1998. Clinical features cannot predict a diagnosis of malaria or differentiate the infecting species in children living in an area of low transmission. Trans R Soc Trop Med Hyg 92 : 45–49. [Google Scholar]
  11. Mason DP, Krudsood S, Wilairatana P, Viriyavejakul P, Silachamroon U, Chokejindachai W, Singhasivanon P, Supavej S, McKenzie FE, Looareesuwan S, 2001. Can treatment of P. vivax lead to a unexpected appearance of falciparum malaria? Southeast Asian J Trop Med Public Health 32 : 57–63. [Google Scholar]
  12. Looareesuwan S, White NJ, Chittamas S, Bunnag D, Harinasuta T, 1987. High rate of Plasmodium vivax relapse following treatment of falciparum malaria in Thailand. Lancet ii : 1052–1054. [Google Scholar]
  13. Krudsood S, Chokejindachai W, Silachamroon U, Phumratanaprapin W, Virayavejakul P, Bussaratid V, Looareesuwan S, 1999. Clinical malaria and treatment of multidrug resistance falciparum in Thailand. Jpn J Trop Med Hyg 27 : 181–188. [Google Scholar]
  14. Mayxay M, Pukrittayakamee S, Chotivanich K, Imwong M, Looareesuwan S, White NJ, 2001. Identification of cryptic coinfection with Plasmodium falciparum in patients presenting with vivax malaria. Am J Trop Med Hyg 65 : 588–592. [Google Scholar]
  15. Pukrittayakamee S, Chantra A, Simpson JA, Vanijanonta S, Clemens R, Looareesuwan S, White NJ, 2000. Therapeutic responses to different antimalarial drugs in vivax malaria. Antimicrob Agents Chemother 44 : 1680–1685. [Google Scholar]
  16. Baird JK, Wiady I, Sutanihardija A, Suradi, Purnomo, Basri H, Sekartuti, Ayomi E, Fryauff DJ, Hoffman SL, 2002. Short report: therapeutic efficacy of chloroquine combined with primaquine against Plasmodium falciparum in northeastern Papua, Indonesia. Am J Trop Med Hyg 66 : 659–660. [Google Scholar]
  17. Nuchprayoon I, Sanpavat S, Nuchprayoon S, 2002. Glucose-6-phosphate dehydrogenase (G6PD) mutations in Thailand: G6PD Viangchan (871G>A) is the most common deficiency variant in the Thai population. Hum Mutat 19 : 185. [Google Scholar]
  18. Buchachart K, Krudsood S, Singhasivanon P, Treeprasertsuk S, Phophak N, Srivilairit S, Chalermrut K, Rattanapong Y, Supeeranuntha L, Wilairatana P, Brittenham G, Looareesuwan S, 2001. Effect of primaquine standard dose (15 mg/day for 14 days) in the treatment of vivax malaria patients in Thailand. Southeast Asian J Trop Med Public Health 32 : 720–726. [Google Scholar]
  19. McIntosh HM, Olliaro P, 1998. Treatment of uncomplicated malaria with artemisinin derivatives. A systematic review of randomised controlled trial. Med Trop (Mars) 58 (suppl 3) : 57–58. [Google Scholar]

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  • Received : 02 Jan 2003
  • Accepted : 10 Mar 2003

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