Rationale for recommending a lower dose of primaquine as a Plasmodium falciparum gametocytocide in populations where G6PD deficiency is common

• Published in: Malaria journal Vol. 11; no. 1; p. 418
• Main Authors: White, Nicholas J, Qiao, Li Guo, Qi, Gao, Luzzatto, Lucio
• Format: Journal Article
• Language: English
• Published: London BioMed Central 14.12.2012; BioMed Central Ltd; BMC
• Subjects: Adult; Anemia, Hemolytic - chemically induced; Anemia, Hemolytic - enzymology; Anemia, Hemolytic - genetics; Animals; Anopheles; Anopheles - parasitology; Anopheles - pathogenicity; Antimalarials - administration & dosage; Antimalarials - adverse effects; Artemisinins - administration & dosage; Artemisinins - adverse effects; Biomedical and Life Sciences; Biomedicine; Complications and side effects; Disease transmission; Dosage and administration; Drug dosages; Drug Therapy, Combination; Entomology; Epidemiology; Erythrocytes; Female; Fever; Gametocytes; Glucosephosphate Dehydrogenase - genetics; Glucosephosphate Dehydrogenase Deficiency - complications; Glucosephosphate Dehydrogenase Deficiency - enzymology; Glucosephosphate Dehydrogenase Deficiency - genetics; Humans; Infectious Diseases; Insect Vectors - parasitology; Insect Vectors - pathogenicity; Malaria; Malaria, Falciparum - complications; Malaria, Falciparum - drug therapy; Malaria, Falciparum - transmission; Male; Microbiology; Mortality; Mosquitoes; Parasitemia - complications; Parasitemia - drug therapy; Parasitology; Physiological aspects; Plasmodium falciparum; Plasmodium falciparum - drug effects; Prevention; Primaquine; Primaquine - administration & dosage; Primaquine - adverse effects; Public Health; Review; Studies; Tropical Medicine; G6PD Activity; Malaria; G6PD Deficiency; Primaquine; Falciparum Malaria
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/1475-2875-11-418

In areas of low malaria transmission, it is currently recommended that a single dose of primaquine (0.75 mg base/kg; 45 mg adult dose) be added to artemisinin combination treatment (ACT) in acute falciparum malaria to block malaria transmission. Review of studies of transmission-blocking activity based on the infectivity of patients or volunteers to anopheline mosquitoes, and of haemolytic toxicity in glucose 6-dehydrogenase (G6PD) deficient subjects, suggests that a lower primaquine dose (0.25 mg base/kg) would be safer and equally effective. This lower dose could be deployed together with ACTs without G6PD testing wherever use of a specific gametocytocide is indicated.