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Rationale for recommending a lower dose of primaquine as a Plasmodium falciparum gametocytocide in populations where G6PD deficiency is common

Nicholas J White1*, Li Guo Qiao2, Gao Qi3 and Lucio Luzzatto4

Author Affiliations

1 Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

2 Research Centre for Qinghao, Guangzhou University of Chinese Medicine, Guangzhou, China

3 Jiangsu Institute of Parasitic Diseases, Wuxi, China

4 Istituto Toscano Tumori, Florence, Italy

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Malaria Journal 2012, 11:418  doi:10.1186/1475-2875-11-418

Published: 14 December 2012


In areas of low malaria transmission, it is currently recommended that a single dose of primaquine (0.75 mg base/kg; 45 mg adult dose) be added to artemisinin combination treatment (ACT) in acute falciparum malaria to block malaria transmission. Review of studies of transmission-blocking activity based on the infectivity of patients or volunteers to anopheline mosquitoes, and of haemolytic toxicity in glucose 6-dehydrogenase (G6PD) deficient subjects, suggests that a lower primaquine dose (0.25 mg base/kg) would be safer and equally effective. This lower dose could be deployed together with ACTs without G6PD testing wherever use of a specific gametocytocide is indicated.