Plasmodium vivax and Pl. ovale have a liver stage that serves as a source for persistent disease with relapse. Primaquine can be given to eliminate the intrahepatic forms (hypnozoites) if there are no contraindications.
Contraindications to the use of primaquine to treat a patient with Pl. vivax or Pl. ovale:
(1) source of infection from blood transfusion or organ transplant (hypnozoites develop from mosquito-transmitted sporozoites).
(2) pregnancy (causes hemolytic anemia in the fetus)
(3) severe G6PD deficiency (results in hemolytic anemia)
(4) milder forms of G6PD deficiency if severe hemolysis develops
(5) permanent residence in an area endemic for Pl. vivax or Pl. ovale
(6) development of severe methemoglobinemia (rare)
In addition, drug resistance results in the need for a higher dose of primaquine if the patient has Pl. vivax acquired in:
(1) Southeast Asia
(2) Papua New Guinea
(3) Solomon Islands
(4) Vanuatu
(5) parts of Indonesia
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