Goodarz Kolifarhood1, Ahmad Raeisi2, Mansour Ranjbar3, Ali Akbar Haghdoust4, Allan Schapira5, Saeed Hashemi6, Hossein Masoumi-Asl7, Hossein Mozafar Saadati1, Sara Azimi1, Nasim Khosravi8, Anatoly Kondrashin9. 1. Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2. Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: Raeisia@tums.ac.ir. 3. Center for Vectors and Vector-Borne Diseases and Department of Biology, Mahidol University, Bangkok, Thailand. 4. Department of Epidemiology and Biostatistics, School of Health, Kerman University of Medical Sciences, Kerman, Iran. 5. Independent consultant, Legazpi City, Philippines. 6. Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 7. Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran. 8. Department of Community Health Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran. 9. Sechenov First Moscow State Medical University, Moscow, Russia.
Abstract
BACKGROUND: With increased international travel over the world the need for safe and effective chemoprophylaxis for malaria is as great as ever. The choice of regimen is difficult, as effectiveness should be weighted against potential adverse effects. Although, some studies have reported high prophylactic efficacy of primaquine, there is no comprehensive evidence comparing its prophylactic effectiveness as well as toxicity. To fill the gap, this systematic review and meta-analysis study was carried out. METHODS: Using MeSH terms, 756 records were detected through searching "Pubmed", "Embase","Web of Science"and "Cochrane" databases. From these,7 relevant full-text articles with 14 comparisons for final quantitative meta-analysis were included in our review. In order to make a comparison between the studies, Risk Ratios(RRs) and their 95% confidence intervals(CIs) were estimated. RESULTS: Overall,74% reduction in the incidence of parasitaemia by primaquine versus other prophylactic regimens was estimated(RRoverall = 0.26, CI 95%:0.16-0.41--RRvivax = 0.16, CI 95%:0.07-0.36--RRfalciparum = 0.31, CI 95%:0.18-0.55). The incidence rate ratios for adverse effects showed no statistically significant difference between primaquine and control groups (p > 0.05). CONCLUSIONS: For persons without G6PD deficiency, who are not pregnant, primaquine is the most effective presently available prophylactic for P. vivax malaria and comparable to such regimens as doxycycline, mefloquine and atovaquone-proguanil for the prevention of P. falciparum malaria.
BACKGROUND: With increased international travel over the world the need for safe and effective chemoprophylaxis for malaria is as great as ever. The choice of regimen is difficult, as effectiveness should be weighted against potential adverse effects. Although, some studies have reported high prophylactic efficacy of primaquine, there is no comprehensive evidence comparing its prophylactic effectiveness as well as toxicity. To fill the gap, this systematic review and meta-analysis study was carried out. METHODS: Using MeSH terms, 756 records were detected through searching "Pubmed", "Embase","Web of Science"and "Cochrane" databases. From these,7 relevant full-text articles with 14 comparisons for final quantitative meta-analysis were included in our review. In order to make a comparison between the studies, Risk Ratios(RRs) and their 95% confidence intervals(CIs) were estimated. RESULTS: Overall,74% reduction in the incidence of parasitaemia by primaquine versus other prophylactic regimens was estimated(RRoverall = 0.26, CI 95%:0.16-0.41--RRvivax = 0.16, CI 95%:0.07-0.36--RRfalciparum = 0.31, CI 95%:0.18-0.55). The incidence rate ratios for adverse effects showed no statistically significant difference between primaquine and control groups (p > 0.05). CONCLUSIONS: For persons without G6PD deficiency, who are not pregnant, primaquine is the most effective presently available prophylactic for P. vivaxmalaria and comparable to such regimens as doxycycline, mefloquine and atovaquone-proguanil for the prevention of P. falciparum malaria.
Authors: Erika L Flannery; Lander Foquet; Vorada Chuenchob; Matthew Fishbaugher; Zachary Billman; Mary Jane Navarro; William Betz; Tayla M Olsen; Joshua Lee; Nelly Camargo; Thao Nguyen; Carola Schafer; Brandon K Sack; Elizabeth M Wilson; Jessica Saunders; John Bial; Brice Campo; Susan A Charman; Sean C Murphy; Margaret A Phillips; Stefan Hi Kappe; Sebastian A Mikolajczak Journal: JCI Insight Date: 2018-01-11