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Long-term Malaria Prophylaxis

12/15/2009

Question:

Dear Pharmacist,

I`ve been taking Doxycycline for malaria prophylaxis for 1 year and 5 months now. I would like to know what is the maximum duration of taking this medicine as prophylaxis because I may stay in the malarial area for up to 5 years. What about other medicines for malaria prophylaxis such as Lariam, or Malarone? Is it possible for me to switch from one prophylaxis to another when I take each prophylaxis to the maximum duration?

Answer:

I have found conflicting information regarding the duration of Doxycycline for malaria prophylaxis. One study reviewed 4 months of prophylaxis, while the United States Centers for Disease Control website (www.cdc.gov) does not have a specific recommendation for any particular time-period.


Doxycycline can bind to calcium and other electrolytes in the stomach and prevent their absorption. This can interfere with bone and teeth development. Doxycycline is not recommended in pregnant women or children. Otherwise, I am unable to find information on the duration in adults.


As far as other options available for the prevention of Malaria, I recommend the CDC website’s page dedicated to this topic: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx.  You will notice a table of drugs used in the prophylaxis of malaria near the bottom of the page (Table 2-23). Above that table, you will also find a section titled Changing Medications during Chemoprophylaxis as a Result of Side Effects. This section discusses the potential need to change medications, and the manner in which it should be done. You will also notice a phone number for the CDC Malaria Hotline (770-488-7788). If you have access to international phone calls, I highly recommend you direct further questions to the experts.

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