Primaquine plus artemisinin combination therapy for reduction of malaria transmission: promise and risk

Reduction of gametocyte transmission from humans to mosquitoes is a key component of malaria elimination. The study by Goncalves and colleagues provides valuable new data on how the addition of low-dose primaquine to artemether-lumefantrine affects reduction of gametocytemia and transmission of gametocytes to mosquitoes in asymptomatically Plasmodium falciparum-infected children without G6PD deficiency, and on the degree to which low-dose primaquine affects hemoglobin levels in these children. The study sets the stage for future research required for consideration of an artemisinin combination therapy (ACT)-primaquine regimen in mass drug administration campaigns. Future studies will need to evaluate toxicity in adults and G6PD deficient persons, assess gametocyte transmission from adults, evaluate different ACT drugs with primaquine, and assess the implications of rare toxicities in large treatment populations, such as hemolysis requiring blood transfusion. The study highlights both the promise and the potential risk of ACT-primaquine treatment in malaria elimination campaigns.