Prevention and treatment of vivax malaria.

Plasmodium vivax is a significant public health threat throughout most of the tropics and to travelers to these regions. The infection causes a debilitating febrile syndrome that often recurs and in rare cases ends in death. The complex life cycle of the parasite compounds the difficulty of prevention and treatment, principally due to the phenomenon of relapse. Most commonly used drugs for preventing malaria fail to prevent late relapses by this parasite. Treatment requires dealing with both blood and liver stages. Since 1950, primaquine has been the only drug available for treatment of liver stages, and important clinical questions surround its appropriate use (ie, dosing, efficacy, safety, and tolerability). Likewise, chloroquine has been first-line therapy for vivax malaria since 1946, and the emergence of resistance to the drug further complicates therapeutic management decisions.