Page 191 - 80 guidelines for the treatment of malaria_opt

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

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.
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.
One trial (71) found that by day 42 the proportion of patients who were anaemic (Hb<10 g/dl) was significantly lower with DHA+PPQ (P = 0.019), but these figures are for participants with
Serious indirectness: only one trial was identified for this comparison; it may not be possible to generalize this in other settings; children weighing <10 kg and pregnant or lactating women
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 treated with AL6.
In Papua, Indonesia, 175 patients randomized to DHA+PPQ or AL (71). All patients also received 14 days of primaquine starting on day 28; this does not reflect normal practice.

No serious limitations: allocation concealment was assessed as “low risk of bias”; laboratory staff were blinded, but there was no other blinding.
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).

Only one trial has compared DHA+PPQ versus AL6+PQ for treating P. vivax.
No imprecision: both limits of the 95% CI imply appreciable benefit of DHA+PPQ over AL.

A9

panel comment: panel conclusion: were excluded.

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