title: Malaria chemoprophylaxis using proguanil/dapsone combinations on the Thai-Cambodian border.
abstract: The Thai-Cambodian border is a difficult area in which to provide adequate malaria chemoprophylaxis because of multiple drug-resistant Plasmodium falciparum. In 1990-1991, Thai soldiers were randomly selected to receive proguanil (200 mg/day) combined with dapsone (4 mg or 12.5 mg/day) (n = 184) or pyrimethamine/dapsone (12.5 mg and 100 mg/week) (n = 177). Doxycycline (100 mg/day) was given to men with glucose-6-phosphate dehydrogenase deficiency (n = 77). Falciparum malaria attack rates were the same whether proguanil/dapsone (10.3%) or pyrimethamine/dapsone (11.3%) was used. However, proguanil/dapsone was more effective than pyrimethamine/dapsone in preventing vivax malaria (1.6% versus 12.4%). Men receiving doxycycline had falciparum malaria (3.9%) and vivax malaria (1.3%) at low rates. Adjusting the dapsone component from 4 mg to 12.5 mg did not improve the prophylactic effectiveness. Hematologic toxicity was not observed with the proguanil/dapsone combination. We conclude that proguanil/dapsone is not a useful alternative for malaria chemoprophylaxis on the Thai-Cambodian border.
authors.affiliation: Department of Medicine, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand.
authors.forename: G D
authors.initials: GD
authors.lastname: Shanks
authors.forename: M D
authors.initials: MD
authors.lastname: Edstein
authors.forename: V
authors.initials: V
authors.lastname: Suriyamongkol
authors.forename: S
authors.initials: S
authors.lastname: Timsaad
authors.forename: H K
authors.initials: HK
authors.lastname: Webster
mesh_terms: D001773:Blood Cells / Q000187:drug effects; D002160:Cambodia; D003622:Dapsone / Q000009:adverse effects / Q000627:therapeutic use*; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000150:complications; D006801:Humans; D007958:Leukocyte Count / Q000187:drug effects; D016778:Malaria, Falciparum / Q000517:prevention & control*; D016780:Malaria, Vivax / Q000517:prevention & control*; D008297:Male; D008889:Military Personnel; D010349:Patient Compliance; D002727:Proguanil / Q000009:adverse effects / Q000627:therapeutic use*; D011739:Pyrimethamine / Q000627:therapeutic use; D013785:Thailand
chemical_list: D003622:Dapsone; D004318:Doxycycline; D002727:Proguanil; D011739:Pyrimethamine