High Efficacy of Primaquine Treatment for Plasmodium vivax in Western Thailand

Rhea J. Longley Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.
Department of Medical Biology, University of Melbourne, Melbourne, Australia.

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Piyarat Sripoorote Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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Pornpimol Chobson Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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Teerawat Saeseu Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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Chonlaphat Sukasem Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

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Suparat Phuanukoonnon Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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Wang Nguitragool Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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Ivo Mueller Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.
Department of Medical Biology, University of Melbourne, Melbourne, Australia.
ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.

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Jetsumon Sattabongkot Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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Primaquine is the only licensed antimalarial drug that is capable of clearing dormant Plasmodium vivax liver stage parasites. To date, there is no clear evidence of resistance of the liver stage parasite against this drug, because of the difficulty in ascertaining the cause of recurrent infection. We followed 52 Thai P. vivax patients for 9 months after directly observed treatment of 15 mg primaquine daily for 14 days. Blood samples taken at 2–4 weekly intervals were assessed by microscopy and polymerase chain reaction (PCR) for the presence of parasites. Only four of 52 (7.7%) volunteers had recurrent P. vivax infections, all at least 8 weeks after treatment. This demonstrates that primaquine retains a high efficacy in this population. Although a risk of new infections could not be ruled out, parasite genotyping at two polymorphic markers suggested a high probability of late relapsing infections in these volunteers. Continued monitoring of primaquine efficacy in this region is advisable.

Author Notes

* Address correspondence to Jetsumon Sattabongkot, Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand. E-mail: jetsumon.pra@mahidol.ac.th

Financial support: This study was funded by the National Institute of Allergy and Infectious Diseases (NIH grant number 5R01 AI 104822) and the Foundation for Innovative New Diagnostics. Ivo Mueller is supported by an NHMRC Senior Research Fellowship (no. 1043345).

Authors' addresses: Rhea J. Longley and Ivo Mueller, Walter and Eliza Hall Institute of Medical Research, Victoria, Australia, E-mails: longley.r@wehi.edu.au and mueller@wehi.edu.au. Piyarat Sripoorote, Pornpimol Chobson, Teerawat Saeseu, Suparat Phuanukoonnon, and Jetsumon Sattabongkot, Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mails: pnt_94@hotmail.com, ppchobson@gmail.com, teerawatsaeseu@gmail.com, suparatp@hotmail.com, and jetsumon.pra@mahidol.ac.th. Chonlaphat Sukasem, Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, E-mail: chonlaphat.suk@mahidol.ac.th. Wang Nguitragool, Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mail: wang.nguitragool@gmail.com.

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