Remarks

• The primaquine high dose (7 mg/kg) should be provided at 1 mg/kg/day for 7 days only to patients with ≥70% G6PDactivity.
• National decisions regarding the two high-dose (7 mg/kg) primaquine regimens given over 7 or 14 days will be affectedby the availability of G6PD semi-quantitative testing and capacity for supervised therapy.
• Evidence for the magnitude of benefit may vary geographically. Whether a high dose of primaquine 7 mg/kg is given in14 days or 7 days, the absolute benefit of using the high primaquine total dose will vary according to the risk ofrecurrence in the population. The benefits are higher in Africa, South-East Asia and Oceania. However, in areas on theIndian subcontinent and in the Americas, where the absolute benefit of a total high dose of 7 mg/kg might be onlymarginally greater than that of 3.5 mg/kg, primaquine at a low 3.5 mg/kg total dose might be used.
• It should be emphasized that determination of G6PD status using appropriate test is needed to guide the safeadministration of primaquine (see section 5.2.1.6 on G6PD testing).

Practical info

• 1.It is appreciated that national decisions regarding the choice of high dose PQ regimens (7.0 mg/kg total dose given at
• 0.5 mg/kg/day for 14 days or 7.0 mg/kg total dose given as 1 mg/kg/day for 7 days) as against the low dose PQ regimen (3.5 mg/kg total dose given at 0.5 mg/kg/day for 7 days) will depend on the risk-benefit analysis depending on local P. vivax relapse rate, the availability of different types of G6PD tests, and capacity for supervised therapy. Our recommendations were based on supervised or semi-supervised PQ administration. Effectiveness might be reduced in unsupervised scenarios.
• 2.Evidence for magnitude of benefit may vary geographically. Primaquine at 3.5 mg/kg total dose for patients with uncomplicated P. vivax malaria might be used in South Asia and the Americas where the absolute benefit of high dose might be small depending on the absolute risk of recurrence following low dose 8-aminoquinolines therapy.
• 3.It should be emphasized that G6PD testing is needed prior to primaquine administration.
• 4.Primaquine can be given except for pregnant women, infants < 1 months of age and women breastfeeding infants < 1 months of age. Secretion of primaquine in breast milk is negligible [229]