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Antimalarials for children with Plasmodium vivax infection: Current status, challenges, and research priorities
Sze-Ann Woon1, Laurens Manning2, Brioni R Moore3
1Medical School, University of Western Australia, Perth, Western Australia, Australia.
Insights
Treating Plasmodium vivax malaria in children requires optimized dosing and formulations. Early clinical trials and accessible G6PD testing are crucial for effective pediatric antimalarial therapies.
Area of Science:
- Tropical Medicine
- Pediatric Pharmacology
- Malaria Research
Background:
- Plasmodium vivax malaria disproportionately affects children, posing a significant public health challenge.
- Relapse due to dormant liver-stage hypnozoites complicates P. vivax treatment and elimination strategies.
- Current pediatric dosing regimens are often extrapolated from adult data, risking suboptimal treatment.
Purpose of the Study:
- To review efficacy and pharmacokinetic data for Plasmodium vivax treatments in children.
- To highlight the critical need for evidence-based pediatric dosing and formulations for P. vivax.
- To emphasize the importance of early phase clinical trials for antimalarial drugs in pediatric populations.
Main Methods:
- This narrative review synthesizes existing literature on P. vivax efficacy and pharmacokinetics in children.
- It examines challenges in pediatric malaria treatment, including hypnozoite relapse and physiological differences.
- The review discusses the implications of adult-extrapolated dosing for pediatric efficacy.
Main Results:
- Paediatric pharmacology is influenced by childhood developmental changes, necessitating specific dosing evaluations.
- Suboptimal dosing in children can occur when regimens are based solely on adult data.
- Development of pediatric formulations and widespread G6PD testing are identified as key priorities.
Conclusions:
- There is an urgent need to evaluate antimalarial dosing in children through early phase clinical trials.
- Prioritizing affordable pediatric formulations and G6PD testing will improve treatment acceptability and efficacy.
- Ensuring safe, effective, and correctly dosed antimalarial therapies for children is essential for malaria elimination efforts.
Abstract:
The aim of this narrative review is to summarise efficacy and pharmacokinetic data for Plasmodium vivax in children. The burden of P. vivax malaria in children continues to remain a significant public health issue, and the need for improved treatment regimens for this vulnerable population is critical. Relapse after re-activation of dormant liver-stage hypnozoites poses additional challenges for treatment, elimination, and control strategies for P. vivax. Whilst it is recognised that paediatric pharmacology may be significantly influenced by anatomical and physiological changes of childhood, dosing regimens often continue to be extrapolated from adult data, highlighting the need for antimalarial dosing in children to be evaluated in early phase clinical trials. This will ensure that globally recommended treatment regimens do not result in suboptimal dosing in children. Furthermore, the development of affordable paediatric formulations to enhance treatment acceptability and widespread G6PD testing to facilitate use of anti-hypnozoite treatment such as primaquine and tafenoquine, should be further prioritised. As the world prepares for malaria elimination, a renewed focus on P. vivax malaria provides an ideal opportunity to harness momentum and ensure that all populations, including children have access to safe, efficacious, and correctly dosed antimalarial therapies.
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