Table 3.

Outstanding questions regarding the use of artemisinin-based combination therapies for vivax malaria

Is the number of P. vivax relapses predetermined or adaptive?

Is primaquine as effective at preventing relapses when used in combination with ACTs as when used with chloroquine?

Is there any increase in inflammatory sequelae, such as lung injury, associated with the use of ACTs for vivax malaria instead of chloroquine?

What is the additional morbidity and mortality of falciparum malaria caused by inadvertent treatment of P. falciparum with chloroquine due to having separate treatment strategies?

If a unified treatment strategy was seen as desirable, which artemisinin-based combination would be the most appropriate for use in co-endemic settings?

What are the operational benefits and disadvantages of a unified versus a separate treatment strategy in co- endemic regions?

What is the cost-effectiveness of using ACTs for the treatment of both vivax and falciparum malaria in co-endemic areas?

Abbreviations: ACT; artemisinin-based combination therapy