Nutritional Advice El Mondo
Objectives:
Chloroquine remains the mainstay of treatment for Plasmodium vivax malaria despite increasing reports of treatment failure. Therefore, this review article has been conducted.
The aim of this review article is to investigate the effect of chloroquine dose and the addition of primaquine on the risk of recurrent vivax malaria across different settings.
Study design:
This review article included 37 Plasmodium vivax clinical trials (from 17 countries) with a total of 5,240 patients (2,990 patients were treated with chloroquine alone, of whom 1041 (34.8%) received a dose below the target 25 mg/kg.
The trials were published between Jan 1, 2000 and March 22, 2017.
Results and conclusions:
The investigators found the risk of recurrence of Plasmodium vivax malaria was 32.4% [95% CI = 29.8-35.1] by day 42.
The investigators found after controlling for confounders, a 5 mg/kg higher chloroquine dose significantly reduced the rate of recurrence overall with 18% [adjusted hazard ratio = 0.82, 95% CI 0.69-0.97, p = 0.021] and in children younger than 5 years with 41% [adjusted hazard ratio = 0.59, 95% CI = 0.41-0.86, p = 0.0058].
The investigators found adding primaquine to chloroquine dose significantly reduced the risk of recurrence to 4.9% [95% CI = 3.1-7.7] by day 42, which is lower than with chloroquine alone (adjusted hazard ratio = 0.10, 95% CI = 0.05-0.17, p 0.0001].
The investigators concluded increasing the recommended dose to 30 mg/kg in children younger than 5 years reduces substantially the risk of early recurrence when primaquine is not given. Radical cure with primaquine is highly effective in preventing early recurrence and also improves blood schizontocidal efficacy against chloroquine-resistant Plasmodium vivax malaria.
Original title:
The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis by Commons RJ, Simpson JA, […], Price RN.
Link:
https://www.ncbi.nlm.nih.gov/pubmed/30033231
Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition right here.