High-dose primaquine reduces vivax relapses: Time for change.

Abstract

After a substantial decline in the number of Plasmodium vivax malaria cases globally over the last two decades, case numbers have rebounded in the last two years,1 highlighting the need for sustained commitment to malaria control and elimination. Optimising case detection and treatment is necessary to achieve elimination. In The Lancet Infectious Diseases, Virak Eng and colleagues2 provide direct evidence of the benefit of high total-dose primaquine (7 mg/kg) compared with low total-dose primaquine (3·5 mg/kg) to prevent relapsing P vivax malaria in Cambodia. These findings provide strong evidence for the optimal primaquine dose for anti-relapse therapy and support the 2024 WHO malaria treatment guidelines update recommending high-dose primaquine in most endemic countries.3