Overall, 10,549 patients (4960 children aged <15 years and 5589 adults) were treated for
falciparum malaria; of these patients, 9385 (89.0%) had Plasmodium falciparum monoinfection and 1164 (11.0%) had mixed P. falciparum/P. vivax
infections according to microscopic examinations performed at screening. The cumulative proportion of patients with P. falciparum
infection recurrence by day 63 was 21.5% (95% confidence interval [CI], 20.3%-22.8%), and the cumulative proportion with P. vivax
infection recurrence was 31.5% (95% CI, 30.1%-33.0%). Significant risk factors for P. vivax
infection recurrence were
mixed infection at enrollment, male sex, younger age, lower hematocrit, higher asexual P. falciparum parasite density (P < .001 for all factors), and P. falciparum gametocytemia at enrollment (P = .001). By day 63, the cumulative risk of
vivax malaria after P. falciparum monoinfection was 51.1% (95% CI, 46.1%-56.2%)
after treatment with rapidly eliminated drugs (t(1/2) <1 day), 35.3% (95% CI, 31.8%-39.0%)
after treatment with intermediate half-life drugs (t(1/2) 1-7 days), and 19.6% (95% CI, 18.1%-21.3%)
after treatment with slowly eliminated drugs (t(1/2) > 7 days) (P < .001, by test for trend).
Artemisinin-based combinations containing
mefloquine or
piperaquine, compared with the
artemether-lumefantrine and
artesunate-
atovaquone-proguanil combinations, were associated with a 3.6-fold to 4.2-fold lower adjusted hazard ratio for P. vivax
infection recurrence within 63 days after pure or mixed P. falciparum
infections (P < .001, for comparisons with
artesunate-
mefloquine).
CONCLUSIONS: