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close this bookGuidelines for the Treatment of Malaria (WHO; 2006; 266 pages) View the PDF document
View the documentGlossary
View the documentAbbreviations
open this folder and view contents1. Introduction
View the document2. The clinical disease
open this folder and view contents3. Treatment objectives
open this folder and view contents4. Diagnosis of malaria
open this folder and view contents5. Resistance to antimalarial medicines9
open this folder and view contents6. Antimalarial treatment policy
open this folder and view contents7. Treatment of uncomplicated P. Falciparum malaria10
open this folder and view contents8. Treatment of severe falciparum malaria14
open this folder and view contents9. Treatment of malaria caused by P. vivax, P. ovale or P. malariae19
View the document10. Mixed malaria infections
close this folder11. Complex emergencies and epidemics
View the document11.1 Diagnosis
View the document11.2 Use of rapid diagnostic tests in epidemic situations
View the document11.3 Management of uncomplicated malaria in epidemics
View the document11.4 Areas prone to mixed falciparum/vivax malaria epidemics
View the document11.5 Use of gametocytocidal drugs to reduce transmission
View the document11.6 Anti-relapse therapy in vivax malaria epidemics
View the document11.7 Mass treatment
open this folder and view contentsAnnexes

11.5 Use of gametocytocidal drugs to reduce transmission

ACTs reduce gametocyte carriage markedly, and therefore reduce transmission. This is very valuable in epidemic control. In the only randomized comparison reported, ACTs had a greater effect than primaquine on gametocyte carriage. In circumstances where an ACT is not used, a single oral dose of primaquine of 0.75 mg base/kg bw (45 mg base maximal for adults) combined with a fully effective blood schizonticide could be used to reduce transmission provided that it is possible to achieve high coverage (> 85%) of the population infected with malaria. This strategy has been widely used in South-East Asia and South America, although its impact has not been well documented. The single primaquine dose was well tolerated and prior testing for G6PD deficiency was not required. There is no experience with its use in Africa, where there is the highest prevalence of G6PD deficiency in the world. Primaquine should not be given in pregnancy. Whether there is any additional benefit in combining primaquine with an ACT is unknown. There is insufficient evidence to recommend this.

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