Treatment of uncomplicated Plasmodium vivax with chloroquine plus radical cure with primaquine without G6PDd testing is safe in Arba Minch, Ethiopia: assessment of clinical and parasitological response

• Published in: Malaria Journal
• Main Authors: Daniel Abebe Mekonnen, Girma Shumie Abadura, Sinknesh Wolde Behaksra, Hiwot Solomon Taffese, Gudissa Aseffa Bayissa, Mikiyas Gebremichael Bulto, Tesfaye Sisay Tessema, Fitsum G. Tadesse, Endalamaw Gadisa
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2023
• Subjects: Chloroquine; Ethiopia; P. vivax; Primaquine; Treatment failure; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arba; Arctic
• Online Access: https://doi.org/10.1186/s12936-023-04562-x; https://doaj.org/article/17bcfce7722a43f991a38af86afa7003

Abstract Background Ethiopia rolled out primaquine nationwide in 2018 for radical cure along with chloroquine for the treatment of uncomplicated Plasmodium vivax malaria in its bid for malaria elimination by 2030. The emergence of anti-malarial drug resistance would challenge the elimination goal. There is limited evidence on the emergence of chloroquine drug resistance. The clinical and parasitological outcomes of treatment of P. vivax with chloroquine plus radical cure using low dose 14 days primaquine were assessed in an endemic area of Ethiopia. Methods A semi-directly observed 42-days follow up in-vivo therapeutic efficacy study was conducted from October 2019 to February 2020. Plasmodium vivax mono-species infected patients (n = 102) treated with a 14 days low dose (0.25 mg/kg body weight per day) primaquine plus chloroquine (a total dose of 25 mg base/kg for 3 days) were followed for 42 days to examine clinical and parasitological outcomes. Samples collected at recruitment and days of recurrence were examined by 18 S based nested polymerase chain reaction (nPCR) and Pvmsp3α nPCR-restriction fragment length polymorphism. Asexual parasitaemia and the presence of gametocytes were assessed on the scheduled days using microscopy. Clinical symptoms, haemoglobin levels, and Hillmen urine test were also assessed. Results Of the 102 patients followed in this study, no early clinical and parasitological failure was observed. All patients had adequate clinical and parasitological responses within the 28 days of follow up. Late clinical (n = 3) and parasitological (n = 6) failures were observed only after day 28. The cumulative incidence of failure was 10.9% (95% confidence interval, 5.8–19.9%) on day 42. Among the paired recurrent samples, identical clones were detected only in two samples on day 0 and day of recurrences (day 30 and 42) using Pvmsp3α genotyping. No adverse effect was detected related to the low dose 14 days primaquine administrations. Conclusion Co-administration of CQ with PQ in the study area is ...