TAFENOQUINE FOR THE TREATMENT OF RECURRENT PLASMODIUM VIVAX MALARIA

SCOTT KITCHENER Centre for Military and Veterans Health, University of Queensland, Herston, Queensland, Australia (formerly of Australian Army Malaria Institute); Australian Army Malaria Institute, Gallipoli Barracks, Enoggera, Queensland, Australia

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PETER NASVELD Centre for Military and Veterans Health, University of Queensland, Herston, Queensland, Australia (formerly of Australian Army Malaria Institute); Australian Army Malaria Institute, Gallipoli Barracks, Enoggera, Queensland, Australia

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MICHAEL D. EDSTEIN Centre for Military and Veterans Health, University of Queensland, Herston, Queensland, Australia (formerly of Australian Army Malaria Institute); Australian Army Malaria Institute, Gallipoli Barracks, Enoggera, Queensland, Australia

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Tafenoquine was used to treat Plasmodium vivax malaria cases who had previously failed treatment with chloroquine and primaquine. Chloroquine was followed by a loading dose of tafenoquine (200 mg base/day for 3 days) and 200 mg a week was given for 8 weeks. One of 27 treated patients relapsed after 6 months of observation. A standard course of chloroquine administered with 8 weeks of tafenoquine may be more effective than chloroquine with primaquine (22.5 mg/day for 14 days) in preventing additional P. vivax relapses. Larger studies are required to optimize the combination, but our findings suggest that an extended use of tafenoquine may be required to prevent relapses of primaquine-tolerant strains of P. vivax malaria.

Author Notes

  • 1

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    Kitchener S, Nasveld P, Bennett S, Torresi J, 2005. Adequate primaquine for vivax malaria. J Travel Med 12 :133–135.

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  • 5

    Kitchener S, 2002. Epidemiology of malaria from East Timor among Australian Defence Force personnel. Trans R Soc Trop Med Hyg 96 :376–377.

  • 6

    Alving AS, Johnson CF, Tarlov AR, Brewer GJ, Kellermeyer RW, Carson PE, 1960. Mitigation of the haemolytic effect of primaquine and enhancement of it’s action against exoerythrocytic forms of the Chesson strain of Plasmodium vivax by intermittent regimens of drug administration: a preliminary report. Bull World Health Organ 22 :621–631.

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  • 7

    Kocisko DA, Walsh DS, Eamsila C, Edstein MD, 2000. Measurement of tafenoquine (WR 238605) in human plasma, and venous and capillary blood by high-pressure liquid chromatography. Ther Drug Monit 22 :184–189.

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  • 8

    Nasveld P, Kitchener S, Edstein M, Rieckmann K, 2002. Comparison of tafenoquine (WR238605) and primaquine in the terminal prophylaxis of vivax malaria in Australian Defence Force personnel. Trans R Soc Trop Med Hyg 96 :683–684.

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  • 9

    Walsh DS, Wilairatana P, Tang DB, Heppner DG, Brewer TG, Krudsood S, Silachamroon U, Phumratanaprapin W, Siriyanonda D, Looareesuwan S, 2004. Randomized trial of 3-dose regimens of tafenoquine (WR238605) versus low-dose primaquine for preventing Plasmodium vivax malaria relapse. Clin Infect Dis 39 :1095–1103.

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  • 10

    Edstein MD, Kocisko DA, Walsh DS, Eamsila C, Charles BG, Rieckmann KH, 2003. Plasma concentrations of tafenoquine, a new long-acting antimalarial agent, in Thai soldiers on monthly prophylaxis. Clin Infect Dis 37 :1654–1658.

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