Doxycycline malaria prophylaxis

Malaria (doxycycline only) Prophylaxis of malaria due to Plasmodium falciparum in short-term travelers (less than 4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains. 

Some in vitro studies have demonstrated that azithromycin is active against chloroquine-sensitive and -resistant strains of Plasmodium falciparum [285]. A trial using daily azithromycin at a dose of 250 mg as a malaria prophylaxis in volunteers has shown azithromycin to be protective against P. falciparum challenge [286,287]. A randomized, placebo-controlled, double-blind study of malaria prophylaxis compared two regimens of azithromycin versus daily doxycycline for a period of 10 weeks in western Kenya [287]. Both regimens with daily azithromycin and doxycycline provided effective prophylaxis of falciparum malaria in this trial. A potential advantage of azithromycin over doxycycline for malaria prophylaxis is... 

Skin Drug rash with eosinophilia and systemic symptoms (DRESS) is relatively common in patients taking minocycline, but seems to be much less so in patients taking doxycychne. However, a report has appeared in a 25-year-old woman of African origin who had been taking doxycycline for malaria prophylaxis for 3 weeks [122 ]. 

Nervous system Benign intracranial hypertension has been reported in a 26-year-old woman who was taking doxycycline for malaria prophylaxis [134 ]. 

Tetracyclines remain the agents of choice in rickettsial infections, and are also used in chlamydial, vibrio, mycoplasmal and spirochaetal infections, brucellosis and the management of chronic bronchitis and acne. They are used in combination with other agents in the treatment of malaria and amoe-biasis, and doxycycline is used for prophylaxis of malaria. 

Schwartz E, Regev-Yochay G. Primaquine as prophylaxis for malaria for nonimmune travelers A comparison with mefloquine and doxycycline. Clin Infect Dis I999 29(6) 1502-6. Lobel HO, Coyne PE, Rosenthal PJ. Drug overdoses with antimalarial agents prescribing and dispensing errors. JAMA 1998 280(17) 1483. 

Tetracycline antibiotics such as doxycycline are also slow-acting schizonticides which have proven to be useful in prophylaxis of malaria and in treatment as one component of combination chemotherapy (80). 

Clinical use The main use of quinine is in P falciparum infections resistant to chloroquine. Quinine is sometimes used with doxycycline to shorten the duration of therapy and limit toxicity. Quinidine, the dextrorotatory stereoisomer of quinine, is used intravenously in the USA for treatment of severe falciparum malaria. To delay emergence of resistance, the drugs should not be used routinely for prophylaxis. 

Tetracyclines, like doxycycline, are broad-spectrum antibiotics with extended use as cheap and effective antibacterials. They act at the level of protein synthesis, and impair, in case of Plasmodium fakiparum, the formation of mero-zoites. Due to a slow onset of activity, doxycycline is used in combination with faster acting drugs for malaria therapy as a single compound it is today applied in prophylaxis, frequently in regions with known chloroquine resistance. 

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