Treatment of Plasmodium Vivax Malaria

ID-10050218Malaria caused by infection of Plasmodium vivax malaria (malarial parasite) is not as serious and life threatening as that with infection by Plasmodium falciparum. Usually infection by P. vivax is not associated with mortality, but it can cause suffering and economic loss to the individual and society. Although not a killer disease (in most cases), P. vivax infection/malaria should be adequately treated.

Treatment of vivax malaria is as follows:

  • Chloroquine 10 mg/kg base (available as tablet chloroquine phosphate 300 mg, which is equivalent to 150 mg base) as first dose (4 tablets chloroquine phosphate 300 mg as first dose) followed by 5 mg/kg base (2 tablets of chloroquine phosphate 300 mg) at 12 hours, 24 hours and 36 or 48 hours after the first dose. Total 10 chloroquine phosphate 300 mg tablets are required for complete treatment. Chloroquine is used for “Clinical Cure” *. For clinical cure of P. vivax malaria, amodiaquine can also be used (10-12 mg/kg once daily at bed time for 3 days). The same regimen can be used for clinical cure of P. ovale, P. malariae also, but not used for P. falciparum.
  • The second antimalarial drug used for primaquine, at the dose of 0.25 mg/kg once daily at bed time for 14 days. This regimen is used for “Radical cure”**, for prevention of relapse. Patients with mild G6PD (glucose-6-phosphate dehydrogenase) deficiency should be given primaquine (for radical cure) at the dose of 0.75 mg/kg once a week for 6 weeks. Patients with severe G6PD deficiency should not be given primaquine because of serious risk of hemolysis.

*What is “Clinical cure”?

Clinical cure in case of infection by P. vivax, is to kill all the parasites from blood (mainly inside the red cells), known as erythrocytic schizonts. Clinical cure cause fever to subside.

Various antimalarial drugs can be used as agents for clinical cure, such as

  • Fast acting drugs for clinical cure include, chloroquine, quinine, mefloquine, halofantrene, lmefantrine, atovaqone, mepacrine, amodiaquine, artemesinin etc.
  • Slow acting drugs for clinical cure include proguanil, sulfonamides, pyremethamine, tetracyclines etc.

**What is “Radical cure”?

Radical cure in P. vivax infection is, killing of exoerythrocytic stage of parasites (known as hypnozoites), which are responsible for relapse of malaria. If only chloroquine (or other agents for clinical cure) is used, it will have no effects on hypnozoites and lead to recurrence of malaria again, later on, without new infection by mosquito bite. To prevent relapse of P. vivax malaria, radical cure agent (most popular is primaquine) is used.

Image courtesy of moomsabuy / FreeDigitalPhotos.net

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