A 28-year-old man from Uttar Pradesh presents with fever and rigors. Peripheral smear shows Plasmodium vivax. He has normal G6PD levels and no history of chloroquine resistance in his area. After completing the course of chloroquine, what additional drug is given for the radical cure of vivax malaria?

• A Sulfadoxine-pyrimethamine as a single dose
• B Artesunate 4 mg/kg daily for 7 days
• C Quinine 10 mg/kg three times daily for 7 days
• D Primaquine 0.25 mg/kg body weight daily for 14 days ✓

Explanation

P. vivax has dormant hypnozoites in the liver that cause relapse weeks to months after the primary attack. Primaquine is the only available drug active against hepatic hypnozoites, so it is given for 14 days at 0.25 mg/kg daily for radical cure, after confirming normal G6PD status because of haemolysis risk. Artesunate and quinine act on blood stages only, while SP has no hypnozoitocidal activity.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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