## Treatment of *Plasmodium vivax* Malaria ### Clinical Context **Key Point:** While artemisinin-based combination therapies (ACTs) are the WHO gold standard for *P. falciparum*, they are NOT universally preferred over chloroquine for *P. vivax* in areas where chloroquine susceptibility remains intact. ### Current Treatment Guidelines | Scenario | First-Line | Rationale | |----------|-----------|----------| | *P. vivax* (chloroquine-susceptible) | Chloroquine + Primaquine | Cost-effective, proven efficacy, low resistance | | *P. vivax* (chloroquine-resistant) | ACT or Atovaquone-proguanil | Emerging resistance in some regions | | *P. falciparum* (all regions) | ACT (artemether-lumefantrine, artesunate-amodiaquine) | High efficacy, resistance containment | | Severe malaria (any species) | IV artesunate | Mortality reduction | **High-Yield:** ACTs are NOT universally preferred for *P. vivax* in India. Chloroquine + primaquine remains guideline-recommended where susceptibility is confirmed. ACTs are reserved for chloroquine-resistant *P. vivax* or as part of containment strategies in high-transmission areas. ### Why This Matters **Clinical Pearl:** The distinction between *P. vivax* and *P. falciparum* treatment is critical: - *P. vivax* requires **hypnozoite elimination** (primaquine) to prevent relapse — ACT alone is insufficient - *P. falciparum* has no hypnozoites; ACT monotherapy is adequate - Using expensive ACTs for all *P. vivax* cases in India wastes resources when chloroquine remains effective ### Primaquine in *P. vivax* **Warning:** Primaquine causes haemolysis in G6PD-deficient patients. Always screen before prescribing. **Mnemonic:** VIVAX = Vivax needs Vivax-specific therapy (primaquine for hypnozoites) [cite:Park 26e Ch 3; WHO Guidelines 2023]
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