Transactions of the Royal Society of Tropical Medicine and Hygiene
Volume 104, Issue 4 , Pages 290-297, April 2010

Doxycycline-chloroquine vs. doxycycline-placebo for malaria prophylaxis in nonimmune soldiers: a double-blind randomized field trial in sub-Saharan Africa

  • Rémy Michel

      Affiliations

    • Institut de Médecine Tropicale du Service de Santé des Armées, BP 46, 13998 Marseille Armées, France
    • Corresponding Author InformationCorresponding author. Tel.: +33 4 91 15 01 80; fax: +33 4 91 52 26 07.
  • ,
  • Sébastien Bardot

      Affiliations

    • Pharmacie Centrale des Armées, BP 04, 45998 Orléans Armées, France
  • ,
  • Benjamin Queyriaux

      Affiliations

    • Institut de Médecine Tropicale du Service de Santé des Armées, BP 46, 13998 Marseille Armées, France
  • ,
  • Jean-Paul Boutin

      Affiliations

    • Institut de Médecine Tropicale du Service de Santé des Armées, BP 46, 13998 Marseille Armées, France
  • ,
  • Jean-Etienne Touze

      Affiliations

    • Direction Centrale du Service de Santé des Armées, BP 125, 00459 Armées, France

Received 6 June 2007; received in revised form 5 October 2009; accepted 5 October 2009.

Summary 

Failures of malaria chemoprophylaxis have been related to a lack of compliance with doxycycline due to its short elimination half-life. Adding a molecule with a long half-life to doxycycline could be useful to take over from this drug in case of occasional missed doses. A double-blind, placebo-controlled randomized field trial was designed to compare the tolerability of a doxycycline-chloroquine combination vs. doxycycline as malaria prophylaxis among French soldiers deployed in Africa. Data from 936 volunteers were analyzed. In both groups, the proportion of volunteers who reported at least one adverse effect was about 57%. Tolerability was similar in the groups except for a higher proportion of nausea or vomiting in the doxycycline-chloroquine group. The reported compliance rate was 86.6% and was similar in the two groups. Eight Plasmodium falciparum malaria cases were diagnosed in the doxycycline group and seven in the doxycycline-chloroquine group. The efficacy of the two chemoprophylaxis regimens was similar. Our study was the first randomized field trial to assess a doxycycline-chloroquine combination as malaria prophylaxis and showed no significant decrease of overall tolerability of the combination compared with doxycycline alone. Our results showed that a doxycycline-chloroquine combination could be a safe combination for malaria chemoprophylaxis.

Keywords: Malaria, Chemoprophylaxis, Doxycycline, Chloroquine, Combination drug therapy, Randomized controlled trial

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 Part of the information included in this paper was presented at: (i) XIIèmes Actualités du Pharo; 7–9 September 2006; Marseilles (France), Poster CA73: Michel R, Bardot S, Boutin J-P, Clair P, Touze, J-E. Efficacité et tolérance comparées de l’association doxycycline-chloroquine vs. doxycycline en chimioprophylaxie du paludisme. Med Trop (Mars) 2006;66:398. (ii) 5th Congress on Tropical Medicine and International Health; 24–28 May 2007; Amsterdam, Oral communication.

PII: S0035-9203(09)00340-X

doi:10.1016/j.trstmh.2009.10.001

Transactions of the Royal Society of Tropical Medicine and Hygiene
Volume 104, Issue 4 , Pages 290-297, April 2010