Page 193 - 80 guidelines for the treatment of malaria_opt

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

importance CRITICAL CRITICAL

Quality LOW VERY LOW
Is PQ (14 days) superior to PQ (5 days) in preventing relapses of P. vivax in adults and children in endemic areas?

235 fewer per 1000 (from 170 fewer 69 fewer per 1000 (from 120 fewer

Absolute to 253 fewer) to 193 more)

effect Relative risk (95% CI) RR 0.1 (0.03–0.35) RR 0.48 (0.1–2 .45)

summary of findings no. of patients PQ (5 d.) PQ (14 d.) + CQ 24/92 2/94 (26.1%) (2.1%) 4/30 2/31 (13.3%) (6.5%)

Other considerations + CQ None None Fourteen days of primaquine may reduce the relapse rate of P. vivax >30 days after primaquine (low quality evidence). However, one very small trial attempted to exclude new infections with PCR and found no statistical difference (very low quality evidence). Serious limitations: in both trial

Imprecision No serious imprecision 4 Very serious 8 Very serious imprecision: the 95% confidence interval includes both appreciable benefit with primaquine (14 days) and appreciable harm.

Indirectness Serious 3 Serious 7 This direct comparison has only been assessed by two small trials. Serious indirectness: both trials enrolled adults only although in one trial the definition of adults was people over the age of 12.

Inconsistency Not applicable EFFICACy: P . vivax parasitaemia detected at > 30 days after starting primaquine, excluding new infections by PCR Not applicable

Limitations EFFICACy: P . vivax parasitaemia detected at >30 days after starting primaquine Serious 2 Serious 6 Serious limitations: allocation concealment was unclear. Serious indirectness: this trial only recruited people over 12 years of age. A9

GRADE Table A9.7.1 Quality assessment Design Randomized trial 1 Randomized trial 5 panel comment: panel conclusion: Brazil (25) and India (26). six months (26). India (26).

studies
No. of
5.
4.
6.
8.
7.
3.
1.
2.
1
2

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