## First-Line Treatment of P. vivax Malaria **Key Point:** Chloroquine remains the drug of choice for uncomplicated P. vivax malaria in India, despite global chloroquine resistance being limited to P. falciparum. ### Rationale for Chloroquine 1. **Efficacy**: P. vivax remains universally sensitive to chloroquine in most endemic regions, including India. 2. **Oral bioavailability**: Well-absorbed and achieves therapeutic levels rapidly. 3. **Safety profile**: Excellent tolerability in non-severe malaria; minimal drug interactions. 4. **Cost-effectiveness**: Economical, making it suitable for resource-limited settings. ### Standard Dosing Chloroquine phosphate (or base equivalent): - **Day 1**: 10 mg/kg (loading dose) - **Day 2**: 5 mg/kg - **Day 3**: 5 mg/kg - Total course: 25 mg/kg over 3 days ### Critical Addition: Primaquine for Hypnozoite Eradication **High-Yield:** P. vivax and P. ovale form hypnozoites in the liver → relapse risk without primaquine. - **Primaquine dose**: 0.25 mg/kg/day for 14 days (or 0.5 mg/kg/day for 7 days) - **Mandatory G6PD screening** before primaquine (risk of haemolysis) - Give primaquine AFTER chloroquine course completes ### Clinical Pearl This patient is haemodynamically stable and alert → uncomplicated malaria → oral chloroquine is appropriate. Artemether and quinine are reserved for severe/complicated malaria or chloroquine resistance (P. falciparum). ### Why Not Artemisinin Derivatives? Artemether is parenteral and reserved for severe malaria (cerebral, acute renal failure, severe anaemia, pulmonary oedema, shock). This patient does not meet severity criteria. [cite:Harrison 21e Ch 219]
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