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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The tolerability of single low dose primaquine in glucose-6-phosphate deficient and normal falciparum-infected Cambodians
BMC Infectious Diseases, Volume 19, No. 1, Article 250, Year 2019
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Description
Background: The WHO recommends single low-dose primaquine (SLDPQ, 0.25 mg/kg body weight) in falciparum-infected patients to block malaria transmission and contribute to eliminating multidrug resistant Plasmodium falciparum from the Greater Mekong Sub region (GMS). However, the anxiety regarding PQ-induced acute haemolytic anaemia in glucose-6-phosphate dehydrogenase deficiency (G6PDd) has hindered its use. Therefore, we assessed the tolerability of SLDPQ in Cambodia to inform national policy. Methods: This open randomised trial of dihydroartemisinin-piperaquine (DHAPP) + SLDPQ vs. DHAPP alone recruited Cambodians aged ≥1 year with acute uncomplicated P. falciparum. Randomisation was 4:1 DHAPP+SLDPQ: DHAPP for G6PDd patients and 1:1 for G6PDn patients, according to the results of the qualitative fluorescent spot test. Definitive G6PD status was determined by genotyping. Day (D) 7 haemoglobin (Hb) concentration was the primary outcome measure. Results: One hundred nine patients (88 males, 21 females), aged 4-76 years (median 23) were enrolled; 12 were G6PDd Viangchan (9 hemizygous males, 3 heterozygous females). Mean nadir Hb occurred on D7 [11.6 (range 6.4 15.6) g/dL] and was significantly lower (p = 0.040) in G6PDd (n = 9) vs. G6PDn (n = 46) DHAPP+SLDPQ recipients: 10.9 vs. 12.05 g/dL, Δ = -1.15 (95% CI: -2.24 -0.05) g/dL. Three G6PDn patients had D7 Hb concentrations < 8 g/dL; D7-D0 Hbs were 6.4 6.9, 7.4 7.4, and 7.5 8.2 g/dL. For all patients, mean (range) D7-D0 Hb decline was -1.45 (-4.8 2.4) g/dL, associated significantly with higher D0 Hb, higher D0 parasitaemia, and receiving DHAPP; G6PDd was not a factor. No patient required a blood transfusion. Conclusions: DHAPP+SLDPQ was associated with modest Hb declines in G6PD Viangchan, a moderately severe variant. Our data augment growing evidence that SLDPQ in SE Asia is well tolerated and appears safe in G6PDd patients. Cambodia is now deploying SLDPQ and this should encourage other GMS countries to follow suit. © 2019 The Author(s).
Available Materials
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https://efashare.b-cdn.net/share/pmc/articles/PMC6419451/bin/12879_2019_3862_MOESM2_ESM.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC6419451/bin/12879_2019_3862_MOESM3_ESM.docx
Authors & Co-Authors
Lek, Dysoley
Cambodia, Phnom Penh
National Centre for Parasitology, Entomology and Malaria Control
Cambodia, Phnom Penh
National Institute of Public Health
Kim, Saorin
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Lopes, Sérgio C.
United Kingdom, London
Malaria Consortium
Khim, Nimol
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Huch, Chea
Cambodia, Phnom Penh
National Centre for Parasitology, Entomology and Malaria Control
Huy, Rekol
Cambodia, Phnom Penh
National Centre for Parasitology, Entomology and Malaria Control
Westercamp, Nelli
United States, Atlanta
Centers for Disease Control and Prevention
Fukuda, Mark M.
United States, Atlanta
Centers for Disease Control and Prevention
Hwang, Jimee
United States, Atlanta
Centers for Disease Control and Prevention
Roca-Feltrer, Arantxa
United Kingdom, London
Malaria Consortium
Mukaka, Mavuto F.J.
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
United Kingdom, Oxford
University of Oxford
Menard, Didier
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
France, Paris
Inserm
Taylor, Walter Robert John
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
United Kingdom, Oxford
University of Oxford
Statistics
Citations: 15
Authors: 13
Affiliations: 8
Identifiers
Doi:
10.1186/s12879-019-3862-1
ISSN:
14712334
Research Areas
Genetics And Genomics
Health System And Policy
Infectious Diseases
Mental Health
Study Approach
Qualitative
Participants Gender
Female