Ultra-short, high-dose primaquine helps prevent P vivax infection in paediatric malaria

For children with uncomplicated malaria, early treatment with an ultra-short course of high-dose primaquine is noninferior to delayed treatment at preventing Plasmodium vivax infection, according to a study.

The study included children aged 0.5–12 years who presented with an axillary temperature >37.5 °C or parentally reported fever and screened positive for malaria during the preceding 24 hours. Following treatment with the combination of artemether plus lumefantrine, the children were randomly assigned to receive primaquine immediately after (early) or 21 days later (delayed).

A total of 219 children were included in the analysis, 110 in the early group and 109 in the delayed group. Of these, 70 percent had P. falciparum and 24 percent had P vivax. With regard to tolerability of treatment, significantly more children in the early group than in the delayed group had abdominal pain (3.7 percent vs 20.9 percent; p<0.0001) and vomiting (0.9 percent vs 9.1 percent; p=0.01).

Early treatment showed noninferiority to delayed treatment in terms of the primary and secondary endpoints of the appearance of any P. vivax parasitemia within 42 or 84 days, respectively. P vivax parasitemia was seen in 14 (13.2 percent) participants in the early group and eight (7.8 percent) in the delayed group (difference, −5.4 percent, 95 percent confidence interval [CI], −13.7 to 2.8) at day 42, and in 36 (34.3 percent) and 17 participants (17.5 percent), respectively (difference, –16.8 percent, –28.6 to –6.1).

The findings support primaquine as universal treatment in areas of high endemicity following uncomplicated malaria with either Plasmodium species.