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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Approach to preventing relapse of malaria due to Plasmodium vivax or Plasmodium ovale

Approach to preventing relapse of malaria due to Plasmodium vivax or Plasmodium ovale
Available antirelapse (hypnozoiticidal) agents* Exclusion criteria Antimalarial (blood schizonticidal) regimen G6PD activity
>70% 30-70% <30% Unavailable
PrimaquineΔ
  • Pregnant
  • Lactating
  • ≤6 months of age
 Chloroquine or an artemisinin combination regimen Adults and children: 0.5 mg base/kg once daily for 14 days (total dose 7 mg/kg over 14 days)◊ Adults and children: 0.5 mg base/kg once daily for 14 days (total dose 7 mg/kg over 14 days)◊ Adults and children: 0.75 mg base/kg once weekly for 8 weeks (total dose 6 mg/kg over 8 weeks)§ Adults and children: 0.25 mg base/kg once daily for 14 days (total dose 3.5 mg/kg over 14 days)¥
Tafenoquine
  • Pregnant
  • Lactating
  • ≤2 years of age
 Chloroquine

Adults and children >35 kg‡: 300 mg single dose on day 1 or day 2 of chloroquine

Children ≤35 kg and aged >2 years‡:

  • >10 kg to 20 kg: 100 mg (two 50 mg dispersible tablets)
  • >20 to ≤35 kg: 200 mg (four 50 mg dispersible tablets)
 Not recommended Not recommended Not recommended
Hypnozoitocidal therapy for preventing relapse of malaria due to P. vivax and P. ovale is administered in combination with appropriate (primary) blood schizonticidal therapy; refer to UpToDate content on nonfalciparum malaria and separately available tables.

G6PD: glucose-6-phosphate dehydrogenase.

* Patients treated with primaquine or tafenoquine should be counseled to report signs of drug-induced hemolysis (dark urine, fatigue, or shortness of breath); in such cases, the drug should be discontinued.

¶ For "normal" G6PD result using a qualitative assay, primaquine is dosed for ≥30% G6PD activity. Use of tafenoquine requires a quantitative G6PD activity assay and a result >70%.

Δ The gastrointestinal tolerability of primaquine can be improved by administering with food.

◊ Doses of primaquine in patients ≥70 kg should be adjusted to a total dose of 7 mg/kg divided into doses of 30 mg per day. The duration of treatment is extended beyond 14 days to achieve total cumulative dose of 7 mg/kg without exceeding the maximum of 30 mg per day. The primaquine dosing regimen differs from 2022 World Health Organization (WHO) guidance; refer to topic on nonfalciparum malaria, section on rationale for use of high-dose primaquine.[1,2]

§ Patients should be evaluated on day 7 to evaluate for adverse effects.

¥ This regimen is sufficient for preventing most P. ovale relapses and is efficacious for prevention of P. vivax relapse for infection acquired in temperate areas and areas of lower relapse periodicity. Patients should be monitored for hemolysis. Refer to the UpToDate topic on nonfalciparum malaria for further discussion.

‡ Pediatric tafenoquine formulation and dosing in children and adolescents aged >2 through 15 years is licensed in Australia but not in the United States.[3]
References:
  1. Chamma-Siqueira NN, Negreiros SC, Ballard SB, et al. Higher-dose primaquine to prevent relapse of Plasmodium vivax malaria. N Engl J Med 2022; 386:1244.
  2. World Health Organization (WHO). Guidelines for Malaria. Geneva, Switzerland: World Health Organization; June 3, 2022.
  3. Kozenis (tafenoquine) Australian Product Information (revision March 2022) available at http://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2018-PI-02316-1 (Accessed on July 19, 2023).
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