Role of Doxycycline in Malaria Treatment and Prophylaxis

Prophylactic Use

• The Centers for Disease Control and Prevention recommends doxycycline as a prophylactic agent in areas of mefloquine-resistant falciparum malaria in East Asia, and as a second-line drug for those visiting high-risk areas but unable to take other antimalarials 1, 2
• For effective prophylaxis, doxycycline should be started 1-2 days before travel to malarious areas and continued daily while in the malarious area and after leaving, according to the MMWR Recommendations and Reports 3

Contraindications and Precautions

• The Centers for Disease Control and Prevention contraindicates doxycycline in pregnant women 5
• The MMWR Recommendations and Reports also contraindicates doxycycline in nursing mothers 3, 5

Special Considerations

• Doxycycline can be used in patients with renal impairment as it is largely metabolized and excreted through the liver, according to the BMJ 1, 2
• Patients taking doxycycline should avoid excessive sun exposure due to the risk of photosensitivity reactions, as reported in the BMJ 1, 2

Treatment Use

• The Clinical Microbiology and Infection journal recommends doxycycline in combination with quinine for the treatment of uncomplicated P. falciparum malaria when artemisinin-based combination therapies are unavailable or contraindicated 4