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Ookluc: A Plasmodium berghei Line for Identifying Transmission-blocking Compounds
Published on: July 11, 2025
Primaquine for reducing Plasmodium falciparum transmission
Patricia M Graves1, Hellen Gelband, Paul Garner
1EpiVec Consulting, Atlanta, USA. pgraves.work@gmail.com.
The Cochrane Database of Systematic Reviews
|September 14, 2012
Summary
Primaquine (PQ) reduces malaria gametocyte density in individuals but evidence of reduced community transmission is lacking. Safety concerns, particularly in individuals with G6PD deficiency, warrant caution in its routine use.
Area of Science:
- Malariology and Tropical Medicine
- Infectious Disease Epidemiology
- Pharmacology and Therapeutics
Background:
- Mosquitoes transmit malaria by ingesting Plasmodium falciparum gametocytes from infected humans.
- Primaquine (PQ) targets gametocytes, and the WHO recommends it to reduce malaria transmission.
- PQ poses a risk of hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency.
Purpose of the Study:
- To evaluate if primaquine (PQ), as an adjunct to primary malaria treatments, reduces Plasmodium falciparum transmission.
- To assess the safety of single-dose or short-course PQ in malaria treatment regimens.
Main Methods:
- Systematic review of 11 individually randomized trials involving 1776 participants.
- Searched multiple databases up to April 2012 for studies comparing antimalarial treatments with or without PQ.
- Analyzed data on gametocyte density, infectiousness to mosquitoes, and adverse effects, stratifying by partner drug.
Main Results:
- Primaquine (PQ) reduced gametocyte prevalence and density in treated individuals, with varying quality of evidence.
- Evidence for PQ reducing infectiousness to mosquitoes was low to moderate quality, depending on the partner drug.
- No trials assessed direct impact on community malaria transmission; safety data, especially regarding G6PD deficiency and hemolysis, were insufficient.
Conclusions:
- Current evidence does not confirm that PQ reduces malaria transmission in endemic communities.
- The risk of developing drug resistance and insufficient safety data, particularly for G6PD deficient populations, are significant concerns.
- Routine use of PQ for malaria treatment should be reconsidered pending further evidence on safety and transmission reduction.
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