Primaquine in P. falciparum Malaria Treatment

Primary Treatment Approach

The World Health Organization recommends using primaquine as a single low dose (0.25 mg/kg) gametocytocidal agent in P. falciparum malaria treatment to reduce transmission, always in combination with appropriate artemisinin-based combination therapy (ACT) 1
First-line treatment for uncomplicated P. falciparum malaria should be artemisinin-based combination therapies (ACTs), specifically artemether-lumefantrine or dihydroartemisinin-piperaquine 2, 3
Primaquine should never be used as monotherapy for P. falciparum; it must always be combined with effective blood schizontocidal drugs 1, 4

For P. falciparum, a single low dose of primaquine (0.25 mg/kg) is recommended, which is significantly lower than the 14-day regimen (0.5 mg/kg/day) used for radical cure of P. vivax/P. ovale 1

G6PD testing should be performed before administering primaquine due to the risk of hemolysis in G6PD-deficient individuals 1
Primaquine is contraindicated during pregnancy and breastfeeding 5, 1

For severe P. falciparum malaria, focus first on treatment with intravenous artesunate; primaquine can be considered once the patient improves and can take oral medications 5, 4
The American Society of Tropical Medicine and Hygiene and other guideline societies recommend the use of primaquine in combination with ACT for the treatment of uncomplicated P. falciparum malaria 1
Coadministration of primaquine with chloroquine boosts blood levels of primaquine, enhancing its efficacy 5