Prophylactic efficacy of primaquine for preventing Plasmodium falciparum and Plasmodium vivax parasitaemia in travelers: A meta-analysis and systematic review.
Goodarz Kolifarhood, Ahmad Raeisi, Mansour Ranjbar, Ali Akbar Haghdoust, Allan Schapira, Saeed Hashemi, Hossein Masoumi-Asl, Hossein Mozafar Saadati, Sara Azimi, Nasim Khosravi, Anatoly Kondrashin
Author Information
Goodarz Kolifarhood: Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ahmad Raeisi: Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: Raeisia@tums.ac.ir.
Mansour Ranjbar: Center for Vectors and Vector-Borne Diseases and Department of Biology, Mahidol University, Bangkok, Thailand.
Ali Akbar Haghdoust: Department of Epidemiology and Biostatistics, School of Health, Kerman University of Medical Sciences, Kerman, Iran.
Allan Schapira: Independent consultant, Legazpi City, Philippines.
Saeed Hashemi: 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.
Hossein Masoumi-Asl: Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran.
Hossein Mozafar Saadati: Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Sara Azimi: Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Nasim Khosravi: Department of Community Health Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran.
Anatoly Kondrashin: Sechenov First Moscow State Medical University, Moscow, Russia.
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.
