A randomized , parallel study of the safety and efficacy of 45 mg primaquine versus 75 mg bulaquine as gametocytocidal agents in adults with blood schizonticide - responsive uncomplicated falciparum malaria

Background: The WHO recommends that adults with uncomplicated P. falciparum successfully treated with a blood schizonticide receive a single dose of primaquine (PQ) 45 mg as a gametocytocidal agent. An earlier pilot study suggested that 75 mg of bulaquine (BQ), of which PQ is a major metabolite, may be a useful alternate to PQ. Methods: In a randomized, partial blind study, 90 hospitalized adults with Plasmodium falciparum malaria that was blood schizonticide-responsive and a gametocytemia of > 55/μl within 3 days of diagnosis were randomized to receive single doses of either PQ 45 mg or BQ 75 mg on day 4. We assessed gametocytemia on days 8, 15, 22 and 29 and gametocyte viability as determined by exflagellation (2° end point) on day 8. Results: On day 8, 20/31 (65%) primaquine recipients versus 19/59 (32%) bulaquine recipients showed persistence of gametocytes (P = 0.002). At day 15 and beyond, all patients were gametocyte free. On day 8, 16/31 PQ and 7/59 BQ volunteers showed gametocyte viability (p = 0.000065). Conclusion: BQ is a safe, useful alternate to PQ as a Plasmodium falciparum gametocytocidal agent and may clear gametocytemia faster than PQ. Introduction Malaria remains the most important parasitic infection with 300–500 million people affected yearly and 1.5–2.7 million deaths each year. World over, malaria control has focused on pharmacological intervention, vector control, curtailing irrational and indiscriminate use of antimalarials, and the development of vaccines. Of these strategies, pharmacological intervention remains the most effective way to combat malaria [1] Published: 01 February 2006 BMC Infectious Diseases 2006, 6:16 doi:10.1186/1471-2334-6-16 Received: 17 May 2005 Accepted: 01 February 2006 This article is available from: http://www.biomedcentral.com/1471-2334/6/16 © 2006 Gogtay et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.