What is the recommended dosage and regimen of doxycycline (Doxycycline) for malaria prophylaxis in travelers to areas with chloroquine-resistant Plasmodium falciparum?

From the Guidelines

Doxycycline is recommended for malaria prophylaxis in travelers to areas with chloroquine-resistant Plasmodium falciparum at a dose of 100 mg once daily. However, the provided evidence does not specify the dosage and regimen of doxycycline for malaria prophylaxis 1.

Key Considerations

• The dosage and regimen of doxycycline for malaria prophylaxis are not explicitly stated in the provided evidence.
• Mefloquine is recommended as the drug of choice for travelers at risk of infection with chloroquine-resistant P. falciparum, with doxycycline as an alternative 1.
• Travelers to areas of risk where drug-resistant P. falciparum is endemic and for whom mefloquine is contraindicated may elect to use an alternative regimen, which could include doxycycline 1.

General Guidance

• When taking doxycycline for malaria prophylaxis, it is generally recommended to begin taking the medication 1-2 days before entering the malaria-endemic area, continue daily throughout the stay, and continue for 4 weeks after leaving the area.
• The medication should be taken at the same time each day with food and a full glass of water to minimize gastrointestinal side effects.
• Remain upright for at least 30 minutes after taking doxycycline to prevent esophageal irritation.
• Doxycycline can increase sun sensitivity, so use sunscreen and protective clothing.
• Women should be aware that doxycycline may reduce the effectiveness of hormonal contraceptives.
• If a dose is missed, take it as soon as remembered, but if it's almost time for the next dose, skip the missed dose and continue with the regular schedule. Never take a double dose to make up for a missed one.

From the FDA Drug Label

For the prophylaxis of malaria: For adults, the recommended dose is 100 mg daily. For children over 8 years of age, the recommended dose is 2 mg/kg given once daily up to the adult dose. Prophylaxis should begin 1 to 2 days before travel to the malarious area. Prophylaxis should be continued daily during travel in the malarious area and for 4 weeks after the traveler leaves the malarious area The recommended dosage and regimen of doxycycline for malaria prophylaxis in travelers to areas with chloroquine-resistant Plasmodium falciparum is:

• Adults: 100 mg daily
• Children over 8 years of age: 2 mg/kg given once daily up to the adult dose Prophylaxis should:
• Begin 1 to 2 days before travel to the malarious area
• Be continued daily during travel in the malarious area
• Be continued for 4 weeks after the traveler leaves the malarious area 2

From the Research

Dosage and Regimen of Doxycycline for Malaria Prophylaxis

• The recommended dosage of doxycycline for malaria prophylaxis is 100 mg per day 3, 4.
• Doxycycline is especially useful as a prophylaxis in areas with chloroquine and multidrug-resistant Plasmodium falciparum malaria 4.
• The protective efficacy of doxycycline was 99% (CI, 94% to 100%) in a study of Indonesian soldiers 3.

Efficacy and Safety of Doxycycline

• Doxycycline is a partially efficacious causal prophylactic (liver stage of Plasmodium) drug and a slow acting blood schizontocidal agent highly effective for the prevention of malaria 4.
• Doxycycline is generally well tolerated, with severe adverse events rarely reported 4, 5.
• Doxycycline users had fewer reported neuropsychiatric events than mefloquine users (RR 0.84,95% CI 0.73 to 0.96) 5.

Comparison with Other Antimalarial Drugs

• Atovaquone-proguanil and doxycycline are the best tolerated regimens, and mefloquine is associated with adverse neuropsychiatric outcomes 5.
• Doxycycline was equally effective in preventing both symptomatic and asymptomatic malarial infections as primaquine and mefloquine in a study in western Kenya 6.
• Chloroquine plus proguanil was the least effective regimen in the same study 6.