Summary Background Chloroquine is the first-line treatment for Plasmodium vivax malaria in most endemic countries, but resistance is increasing. Monitoring of antimalarial efficacy is essential, but in P vivax infections the assessment of treatment efficacy is confounded by relapse from the dormant liver stages. We systematically reviewed P vivax malaria treatment efficacy studies to establish the global extent of chloroquine resistance. Methods We searched Medline, Web of Science, Embase, and the Cochrane Database of Systematic Reviews to identify studies published in English between Jan 1, 1960, and April 30, 2014, which investigated antimalarial treatment efficacy in P vivax malaria. We excluded studies that did not include supervised schizonticidal treatment without primaquine. We determined rates of chloroquine resistance according to P vivax malaria recurrence rates by day 28 whole-blood chloroquine concentrations at the time of recurrence and study enrolment criteria. Findings We identified 129 eligible clinical trials involving 21 694 patients at 179 study sites and 26 case reports describing 54 patients. Chloroquine resistance was present in 58 (53%) of 113 assessable study sites, spread across most countries that are endemic for P vivax . Clearance of parasitaemia assessed by microscopy in 95% of patients by day 2, or all patients by day 3, was 100% predictive of chloroquine sensitivity. Interpretation Heterogeneity of study design and analysis has confounded global surveillance of chloroquine-resistant P vivax , which is now present across most countries endemic for P vivax . Improved methods for monitoring of drug resistance are needed to inform antimalarial policy in these regions. Funding Wellcome Trust (UK).

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(14)70855-2.pdf

Global extent of chloroquine-resistant Plasmodium vivax: a systematic review and meta-analysis

Identification of key odorants responsible for chestnut-like aroma quality of green teas.

The diagnosis and treatment of Plasmodium vivax malaria differs from that of Plasmodium falciparum malaria in fundamentally important ways. This article reviews the guiding principles, practices, and evidence underpinning the diagnosis and treatment of P. vivax malaria.

/pdf/diagnosis-and-treatment-of-plasmodium-vivax-malaria-4ftx1e4ghu.pdf

Diagnosis and Treatment of Plasmodium vivax Malaria.

Separation of aroma components in Xihu Longjing tea using simultaneous distillation extraction with comprehensive two-dimensional gas chromatography-time-of-flight mass spectrometry

Purpose of Review
For over 50 years the treatment of Plasmodium vivax has relied on a combination of chloroquine plus primaquine, but this strategy is under threat. Chloroquine efficacy is now compromised across much of the vivax endemic world and there are significant operational difficulties in deploying primaquine. We review the recent advances in P. vivax chemotherapy that may influence the future management of this neglected pathogen.

/pdf/plasmodium-vivax-treatments-what-are-we-looking-for-3xy2kogwmh.pdf

Plasmodium vivax treatments: what are we looking for?

The Republic of Korea (ROK) Army instituted a vivax malaria chemoprophylaxis program (hydroxychloroquine [HCQ] 400 mg per week) in 1997 that was expanded to nearly 200,000 soldiers by 2007, raising concerns for the emergence of drug-resistant vivax malaria. Therefore, a study of whole blood HCQ concentrations for all malaria patients admitted to four ROK Army hospitals was conducted from June through September 2007. For all 142 vivax malaria patients enrolled, fevers returned to normal by Day 3 post-treatment and all thin blood films were negative for parasites by Day 7. Pre-treatment whole blood concentrations of HCQ for 14 patients were > 100 ng/mL. Eight of the patients were enrolled in the ROK Army chemoprophylaxis program that reported taking HCQ as directed, with the last pill taken > or = 4 days before diagnosis. Although there was no evidence of clinical resistance, chemoprophylaxis data indicates the biological resistance or tolerance to HCQ in ROK.

Biological resistance of hydroxychloroquine for Plasmodium vivax malaria in the Republic of Korea.

https://ir.ymlib.yonsei.ac.kr/bitstream/22282913/105088/1/T200903487.pdf

Biological resistance of hydroxychloroquine for Plasmodium vivax malaria in the Republic of Korea

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Biological resistance of hydroxychloroquine for Plasmodium vivax malaria in the Republic of Korea.

Biological resistance of hydroxychloroquine for Plasmodium vivax malaria in the Republic of Korea