Plasmodium vivax: current therapeutic strategies

Impact of Plasmodium vivax worldwide: Plasmodium vivax is the most widespre ad malarial agent in the world. Unlike Plasmodium falciparum, Fl vivax can cause early or late recurrence and is not fatal (benign tertian malaria). Emergence of resistant strains: P vivax strains resistant to chloroquine, t hen primaquine, have emerged over the last decade, creating the need for a new therapeutic strategy. I Treatment of primary disease: Generally, chloroquine is the first intention treatment, excepting patients who also have Fl folciparum infection or a s train with suspected resistance to chloroquine. Mefloquine, quinine and hal ofantrine are also logical alternatives. Treatment of recurrent disease: A schizonticidal agent should be given foll owed by a hypnozoitocidal agent, primaquine. Primaquine dosage should now b e raised or adjusted to the patient's weight. Therapeutic perspectives: Tafenoquine, delayed-release amino-8-quinoleine, is a potential alternative for primaquine for the treatment of recurrences. Studies are also in progress to evaluate the role of primaquine as a proph ylaxic agent.