Primaquine 30?mg/day versus 15?mg/day during 14?days for the prevention of Plasmodium vivax relapses in adults in French Guiana: a historical comparison

摘要

Abstract BackgroundThe preventive treatment of Plasmodium vivax relapse recommended by the World Health Organization is primaquine at a dose of 15?mg/day for 14?days, except for malaria cases from Asia and Oceania. Since 2006, CDC recommends the use of primaquine at 30?mg/day for 14?days. In France, all cases of malaria due to P. vivax are treated with 30?mg of primaquine. This systematically increased dosage needs to be evaluated according to epidemiological context. The aim of the study was to compare relapses after 14?days of primaquine at 15 or 30?mg/day.MethodsAll patients treated with primaquine after a vivax malaria episode in French Guiana, between 1 January, 2007 and 1 August, 2016, were studied. Based on the compulsory hospital pharmacy forms for primaquine delivery, adult patients who received 15 or 30?mg of primaquine during 14?days for hypnozoite eradication were included. The recommended dose was initially 15?mg and was changed to 30?mg in 2011. Vivax malaria recurrences within 2?months after primaquine treatment, and vivax malaria recurrences 2–6?months after primaquine in each treatment group were analysed using survival analysis at 2, 3 and 6?months.ResultsOut of 544 patients included, 283 received 15?mg/day and 261 received 30?mg/day of primaquine. At 2 and 3?months after primaquine treatment, the number of recurrences was 7 (2.5%) and 19 (7.3%), and 9 (3.4%) and 15 (5.3%), in the 15 and 30?mg groups (p?=?0.51 respectively 0.35), respectively. Within 3?months, the median time to recurrence was 2.05?months in the 15 and 30?mg groups. At 6?months after primaquine treatment, the number of recurrences was 25 (8.8%) and 31 (11.9%) at 15 and 30?mg, respectively (p?=?0.24). The median time to recurrence was 2.38?months at 15?mg/day and of 2.64?months at 30?mg/day.ConclusionsThere were no significant differences between primaquine at 15 or 30?mg/day for 14?days in the prevention of P. vivax relapses at 2, 3 and 6?months after primaquine treatment in French Guiana.