Piperaquine, recrudescence and gametocytes

Several papers indicate that piperaquine compared to other antimalarials leads to a high level of recrudescence and a higher gametocytogenesis. Gametes are even generatd by piperaquine in asymptomatic patients with low asexual parasite densities. Reuling IJ, van de Schans LA, Sauerwein RW, Bousema T. A randomized feasibility trial comparing four antimalarial drug regimens to induce Plasmodium falciparum gametocytemia in the controlled human malaria infection model. Elife. 2018 Feb 27;7:e31549. Pasay CJ, Rockett R, Sekuloski S, et al. Piperaquine Monotherapy of Drug-Susceptible Plasmodium falciparum Infection Results in Rapid Clearance of Parasitemia but Is Followed by the Appearance of Gametocytemia. J Infect Dis. 2016;214(1):105-113. Ryan Farid, Matthew W. Dixon, Leann Tilley, James S McCarthy, Initiation of gametocytogenesis at very low parasite density in Plasmodium falciparum infection, The Journal of Infectious Diseases, Volume 215, Issue 7, 1 April 2017, Pages 1167–1174,