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Efficacy of Three Different Regimens of Primaquine for the Prevention of Relapses of Plasmodium vivax Malaria in the Amazon Basin of Peru

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  • US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Instituto Nacional de Salud, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Direccion Regional de Salud Loreto, Iquitos, Peru; US Naval Medical Center San Diego, San Diego, California

We evaluated the efficacy of three primaquine (PQ) regimes to prevent relapses with Plasmodium vivax through an open-label randomized trial in Loreto, Peru. Vivax monoinfections were treated with chloroquine for 3 days and PQ in three different regimes: 0.5 mg/kg per day for 5 days (150 mg total), 0.5 mg/kg per day for 7 days (210 mg total), or 0.25 mg/kg per day for 14 days (210 mg total). Biweekly fever assessments and bimonthly thick smears were taken for 210 days. Recurrences after 35 days were considered relapses. One hundred eighty cases were enrolled in each group; 90% of cases completed follow-up. There were no group-related differences in age, sex, or parasitemia. Relapse rates were similar in the 7- and 14-day regimes (16/156 = 10.3% and 22/162 = 13.6%, P = 0.361) and higher in the 5-day group (48/169 = 28.4%, P < 0.001 and P = 0.001, respectively). The 7-day PQ regimen used in Peru is as efficacious as the recommended 14-day regimen and superior to 5 treatment days.

Author Notes

* Address correspondence to Salomón Durand, US Naval Medical Research Unit No. 6 (NAMRU-6), Av. La Marina S/N, Iquitos, Peru. E-mail: salomondurand@gmail.com

Financial support: This study was supported by the US Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS) Work Unit Number 847705.82000.25GB.B0016, the National Institute of Health of Peru, and the Pan-American Health Organization/US Agency for International Development (PAHO-USAID) Americas Malaria Initiative/Amazonic Network of Antimalarial Drug Resistance, AMI/RAVREDA project. A.G.L. is also sponsored by Training Grant 2D43 TW007393 awarded to the US Naval Medical Research Unit No. 6 by the Fogarty International Center of the US National Institutes of Health.

Authors' addresses: Salomón Durand, Meddly L. Santolalla, and David J. Bacon, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru, E-mails: salomondurand@gmail.com, med_robles@hotmail.com, and david.bacon@nrl.navy.mil. Cesar Cabezas, Instituto Nacional de Salud, Lima, Peru, and Universidad Nacional Mayor de San Marcos, Lima, Peru, Email: ccabezas@ins.gob.pe. Andres G. Lescano, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru, and Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: willy.lescano@med.navy.mil and wlescano@hotmail.com. Mariela Galvez and Carlos Alvarez, Direccion Regional de Salud Loreto, Iquitos, Peru, E-mails: mariel_gal@hotmail.com and calvarez@diresaloreto.gob.pe. Sonia Gutierrez and Nancy Arrospide, Instituto Nacional de Salud, Lima, Peru, E-mails: sgutierrez@ins.gob.pe and narrospide@hotmail.com. Paul C. F. Graf, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru, and US Naval Medical Center San Diego, San Diego, CA, E-mail: Paul.Graf@med.navy.mil.

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