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The ACTs were dihydroartemisinin piperaquine (DHAPP), artesunate pyronaridine (ASPYR), artesunate amodiaquine (ASAQ), artesunate mefloquine (ASMQ), artemether lumefantrine (AL), and ALAQ. Tablet strengths were predefined: 2.5, 3.75, 5, 7.5, and 15 mg, and no tablet fractions were allowed. The maximum mg\/kg dose was set at 0.5, and, primarily for ease of ACT co-blistering, 1 tablet\u2009=\u20091 dose. We assessed different mg\/kg doses and selected the dosing associated with a predicted median exposure closest to 1200 ng*h\/mL, the exposure predicted for a 60 kg individual given 15 mg of PQ.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The designed 8 regimens had 4\u20138 dosing bands. The stand-alone, DHAPP, and ASPYR regimens contain the full line of PQ tablets and all other regimens, except AL (2.5, 7.5, 15 mg) and ALAQ (2.5, 5, 7.5, 15 mg), use 3.75 mg. The 2.5 mg tablet resulted in a maximum dose of 0.56 mg\/kg for ASAQ, as this regimen starts at 4.5 kg body weight, whilst all other regimens start at 5 kg and resulted in 0.5 mg\/kg. Substituting 3.75 mg with 5 mg results in maximum doses of 0.56 mg\/kg (ASAQ, ASMQ) and 0.63 mg\/kg (other regimens), risking greater toxicity. Across all dosing bands, 0.17\u2009\u2212\u20090.56 mg\/kg doses predict exposures of\u2009~\u2009500\u2009\u2212\u20092000 ng*mL\/h. Regimens with more dosing bands had less variations in exposure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>These regimens offer flexibility for malaria control programmes and guidance for drug manufacturers wishing to co-blister SLDPQ with ACTs. The WHO should reinstate the 3.75 mg tablet for prequalification and determine which regimens should be incorporated into their treatment guidelines to advance malaria elimination.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration<\/jats:title>\n            <jats:p>The trial is registered at ISRCTN, number 11594437.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12916-025-04153-4","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T14:48:55Z","timestamp":1751381335000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Single low dose primaquine to block the transmission of Plasmodium falciparum\u2014proposed stand-alone and ACT-adapted regimens"],"prefix":"10.1186","volume":"23","author":[{"given":"Walter R. 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