Treatment of P. vivax or P. ovale Malaria with G6PD Deficiency (<30% of Normal G6PD Activity)

When Plasmodium vivax or Plasmodium ovale malaria occurs in a patient with significant G6PD deficiency — confirmed at less than 30% of normal enzyme activity — the standard relapse-prevention approach must be modified. This specific situation calls for a carefully supervised protocol distinct from standard regimens.

Clinical Scenario

      P. vivax or P. ovale malaria in a patient with G6PD deficiency at less than 30% of normal activity. The severity of G6PD deficiency at this threshold directly determines which relapse-prevention strategy is appropriate and how it must be monitored.
    

Treatment Approach

Relapse prevention is achievable in this setting, but requires a modified dosing schedule of primaquine administered under close medical supervision — with active surveillance for haemolysis throughout the course.

The complete schedule, monitoring requirements, and full structured regimen are available in the protocol below.

Instant Access to Structured Evidence-Based Regimens

References

If the patient has G6PD activity < 30%, consider primaquine 0.75 mg/kg once a week for 8 weeks under medical supervision and surveillance for haemolysis.

In people with G6PD deficiency, primaquine base at 0.75 mg/kg bw once a week for 8 weeks can be given to prevent relapse, with close medical supervision for potential primaquine-induced haemolysis.

In patients known to be G6PD deficient, primaquine may be considered at a dose of 0.75 mg base/kg bw once a week for 8 weeks.

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