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P. vivax Radical Cure — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesP. vivax Radical CureRACP Adult Medicine

A 40-year-old woman returns from sub-Saharan Africa with cyclical fevers every 48 hours. Blood film shows Plasmodium vivax trophozoites. After treating the acute infection with chloroquine, what additional treatment is required?

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Correct answer: C — Primaquine for 14 days (to eliminate hypnozoites)

P. vivax (and P. ovale) form dormant hypnozoites in the liver that can cause relapses months to years after initial infection. Primaquine (0.5 mg/kg daily for 14 days) is required to achieve radical cure by eliminating hypnozoites. G6PD testing MUST be performed before starting primaquine – G6PD-deficient patients develop severe haemolysis. For G6PD-deficient patients, tafenoquine or modified primaquine dosing (0.75 mg/kg weekly for 8 weeks with close monitoring) is an alternative.

Reference: eTG – 2025 – Antibiotic Guidelines; WHO – 2022 – Malaria Treatment Guidelines