Daniel Yilma, Kasia Stepniewska, Teun Bousema, Chris Drakeley, Prashanti Eachempati, Philippe J Guerin, Andreas Mårtensson, Richard Mwaiswelo, Walter R Taylor, Karen Barnes on behalf of the WWARN Paediatric Primaquine for P falciparum Transmission Blocking Study Group
Safety and efficacy of single-dose primaquine to interrupt Plasmodium falciparum malaria transmission in children compared with adults: a systematic review and individual patient data meta-analysis
Doi: 10.1016/S1473-3099(25)00078-7
What is this publication about?
Primaquine is an antimalarial drug the WHO currently recommends is used as a single dose of 0,25 mg/kg in areas with low malaria transmission to block malaria transmission and advance malaria elimination. It is currently mainly used in older children and adults, as it comes in tablets that are difficult for younger children to use.
The publication’s authors combined all available individual patient data on the drug in young children and found that an addition of a single dose of 0,25 mg/kg primaquine to the standard malaria treatment is effective and safe for reducing P. falciparum transmission, across all age groups in areas of low and moderate-to-high malaria transmission intensity.
Why is this important?
Currently, artemisinin-based combination therapies (ACTs) are the WHO-recommended treatment for uncomplicated P. falciparum malaria. However, the emergence and spread of artemisinin resistance (ART-R) threaten ACT efficacy. Research into the safety and effectiveness of treatment strategies that may be able to block transmission of malaria parasites is, therefore, one of the key strategies for addressing drug-resistant malaria.
These new findings emphasise the need to develop primaquine formulations suitable for young children and provide evidence for expanded use of single low-dose primaquine in areas with drug-resistant malaria, including in areas of moderate-to-high transmission intensity that bear the highest malaria burdens.
By combining existing individual patient data, the researchers also saved the time and expense of conducting new clinical trials in children.
How can this make a difference?
The recently observed emergence and spread of antimalarial resistance, including in Southern and Eastern Africa, is a major threat to malaria control and elimination, putting the health of millions at risk.
This publication contributes to the evidence that can support timely regulatory and health policy responses to the threat of drug-resistant malaria, including expanding the use of single low-dose primaquine to areas of moderate-to-high transmission intensity and to young children when a suitable paediatric formulation becomes available.