Primaquine toxicity forestalls effective therapeutic management of the endemic malarias

► Current strategy for treatment of clinical disease relies on species- and stage-specific therapies guided by diagnosis. ► This strategy derives from two historic biases favouring management of malaria in travellers. ► Elimination therapy means attacking all species and stages regardless of diagnostic outcome or availability. ► Hemolytic toxicity of primaquine in G6PDd patients is the primary impediment to therapies for managing endemic malarias. ► A research agenda for optimising primaquine therapy when combined with modern antimalarials is needed.