MEFLOQUINE COMPARED WITH DOXYCYCLINE FOR THE PROPHYLAXIS OF MALARIA IN INDONESIAN SOLDIERS - A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLEDTRIAL

Background: Mefloquine and doxycycline are the two drugs recommended f or prophylaxis of malaria for visitors to areas where Plasmodium falci parum is resistant to chloroquine. Objective: To compare the efficacy and tolerability of mefloquine with those of doxycycline as prophylaxi s for malaria. Design: Randomized, double-blind, placebo-controlled fi eld trial of chemoprophylaxis of malaria. Setting: Northeastern Irian Jaya, Indonesia. Participants: 204 Indonesian soldiers. Intervention: After radical curative treatment, participants were randomly assigned to receive 100 mg of doxycycline per day and mefloquine placebo; 250 m g of mefloquine per week (preceded by a loading dose of 250 mg/d for 3 days) and doxycycline placebo; or placebos for both drugs. Prophylaxi s lasted approximately 13 weeks. Measurements: The primary end point f or efficacy was the first occurrence of malaria, as documented by a po sitive malaria smear. Malaria smears were obtained weekly I and when p atients had symptoms suggesting malaria. Reported symptoms were record ed daily, and an exit study questionnaire was conducted. Results: In t he placebo group, 53 of 69 soldiers developed malaria (9.1 person-year s), resulting in an attack rate of 5.8 cases per person-year (95% CI, 4.3 to 7.7 cases per person-year). Plasmodium falciparum accounted for 57% of cases, and P. vivax accounted for 43% of cases. No malaria occ urred in the 68 soldiers (16.9 person-years) in the mefloquine group; thus, the protective efficacy of mefloquine was 100% (CI, 96% to 100%) . In the doxycycline group, P. falciparum malaria occurred in 1 of 67 soldiers (16.0 person-years), yielding a protective efficacy of 99% (C I, 94% to 100%). Both drugs were very well tolerated. Conclusions: Mef loquine and doxycycline were both highly efficacious and well tolerate d as prophylaxis of malaria in Indonesian soldiers.