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Primaquine Prophylaxis against Malaria in Nonimmune Colombian Soldiers: Efficacy and Toxicity: A Randomized, Double-Blind, Placebo-Controlled Trial

Jaime Soto, MD; Julia Toledo, MD; Maria Rodriquez, Med Tech; Jorge Sanchez, Med Tech; Ricardo Herrera, MD; Julio Padilla, MD; and Jonathan Berman, MD, PhD

1 August 1998 | Volume 129 Issue 3 | Pages 241-244

Background: Primaquine had a prophylactic efficacy of 90% to 95% against infection with Plasmodium falciparum and P. vivax in Indonesian settlers.

Objective: To evaluate the efficacy of primaquine prophylaxis for protecting nonimmune persons from malaria.

Design: Randomized, double-blind, placebo-controlled field study.

Setting: A malaria-endemic area in Colombia.

Patients: 176 healthy, young, nonimmune adult male soldiers.

Intervention: Primaquine, 30 mg/d, or matching placebo during 15 weeks of patrol in the endemic area and 1 week afterward.

Measurements: Symptomatic parasitemia was determined over the 16-week intervention period and for 3 weeks in base camp.

Results: Protective efficacy in the primaquine group (122 participants) was 89% (95% CI, 75% to 96%) against all types of malaria, 94% (CI, 78% to 99%) against P. falciparum malaria, and 85% (CI, 57% to 95%) against P. vivax malaria. Six primaquine recipients had mild to moderate gastrointestinal distress, and three had severe distress.

Conclusions: For prophylaxis against P. falciparum malaria, primaquine has an efficacy and toxicity competitive with those of standard agents. A potential advantage of primaquine is that prophylaxis may be discontinued 1 week after the recipient has left the endemic area.

Author and Article Information

From Universidad Militar Nueva Granada, Consorcio de Investigaciones Bioclinicas, Direccion de Sanidad Ejercito, and Ministerio de Salud, Bogota, Colombia; and Walter Reed Army Institute of Research, Washington, D.C.
Acknowledgments: The authors thank Dr. Ohrt for critical review of the manuscript.
Grant Support: By grant 95-01 from the AB Foundation for Medical Research.
Requests for Reprints: Jaime Soto, MD, Universidad Militar Nueva Granada, Calle 100 con Cra 11, Santafe de Bogota, DC, Colombia.
Current Author Addresses: Dr. Soto: Universidad Militar Nueva Granada, Calle 100 con Cra 11, Santafe de Bogota, DC, Colombia. Dr. Toledo: Consorcio de Investigaciones Bioclinicas CIBIC, Calle 60 A # 5-54, Oficina 201, Santafe de Bogota, DC, Colombia. Ms. Rodriguez: Direccion de Sanidad Ejercito, Avenida 7 con Calle 53, Santafe de Bogota, DC, Colombia.

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