Primaquine for Plasmodium vivax malaria treatment - Authors' reply.

We agree with Harin Karunajeewa and Robert James that radical cure of Plasmodium vivax malaria needs to be deployed more widely. The question is, how do we achieve this? Shortening the treatment course and thereby improving adherence is an important step in the right direction.1 Primaquine regimens are usually extended over 14 days to reduce the daily dose and thereby improve tolerability and safety. The main adverse event risk is haemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The primary reason why the prolonged regimen is still recommended is the lack of G6PD testing in vivax-endemic countries.2 Novel point-of-care G6PD tests herald a new era, in which the use of different dosing regimens can be explored.