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Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers
1995

Prevention of Relapses of Malaria Due to P. vivax or P. ovale

P. vivax and P. ovale have a persistent liver phase that is responsible for relapses and is susceptible only to treatment with primaquine, which is available on prescription in Canada. In order to reduce the risk of relapse following the treatment of symptomatic P. vivax or P. ovale infection, primaquine is indicated to provide "radical cure". Primaquine is not recommended for routine use to prevent relapsing malaria in returning travellers. Primaquine use is contraindicated in pregnancy.

Most people tolerate primaquine very well, but individuals with glucose 6-phosphate dehydrogenase deficiency (G6PD) may experience serious hemolysis when using it. Patients of Mediterranean, African, and Asian ethnic origin or those receiving >> 15 mg dose per day of primaquine have a greater risk of hemolysis. These individuals, in particular, should have G6PD levels measured. In cases where G6PD levels are very low, an infectious or tropical disease expert should be consulted. Primaquine should be initiated after chloroquine therapy has been completed and the acute febrile illness is over (about 1 to 2 weeks). Patients should be advised to stop their medication and report to a physician immediately if jaundice or abnormally dark or brown urine is noted.

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