Page 189 - 80 guidelines for the treatment of malaria_opt

ANNEX 9. Treatment of Plasmodium vivax, P. ovale and P. malariae infections

There were three serious adverse events in the group treated with AS+AQ and none with DHA-PPQ. However these events may have occurred in participants with P. falciparum only so they are
Serious imprecision: P. vivax parasitaemia was successfully cleared in all participants in both groups in this trial; further trials are necessary to confirm the absence of any important differences.
Serious indirectness: only one trial was found to be assessing this comparison; it may not be possible to generalize this result in other settings; children aged <1 year and pregnant or lactating
One trial (70) found that the proportion anaemic (HB<10 g/dl) was significantly higher in the group treated with AS+AQ on days seven (P = 0.04) and 28 (P = 0.019), but these figures are for
Due to the long-half life of DHA+PPQ, it is likely that it still provides some prophylactic effect at day 42. There is the possibility that effects seen at day 42 may be lost as follow-up continues.
participants with P. vivax mono-infection, or P. falciparum mono-infection or mixed infection at baseline; both P. vivax and P. falciparum were more common during follow-up in the group
No serious limitations: sequence generation and allocation concealment were adequate; all participants were offered a course of unsupervised primaquine with no further details given

There may be some benefit in using DHA+PPQ (drugs with longer half-lives) in reducing the prevalence of anaemia.

DHA+PPQ performed significantly better at reducing relapses at day 42 (moderate quality evidence).

regarding who took or completed this treatment; only laboratory staff were blinded to treatment allocation.
No serious imprecision: both limits of the 95% CI imply appreciable benefit with DHA+PPQ over AS+AQ.
Only one trial has compared DHA-PPQ+PQ versus AS+AQ+PQ for treating P. vivax.

No serious limitations: sequence generation and allocation concealment were adequate.

Papua, Indonesia (70), 114 patients randomized to DHA+PPQ or AS+AQ.

A9

panel comment: panel conclusion: women were excluded. treated with AS+AQ. not included in this table.

8.
3.
2.
5.
9.
4.
1.
7.
6.

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