title: Chloroquine/doxycycline combination versus chloroquine alone, and doxycycline alone for the treatment of Plasmodium falciparum and Plasmodium vivax malaria in northeastern Irian Jaya, Indonesia.
abstract: Combination therapy is one method of overcoming the global challenge of drug-resistant Plasmodium falciparum malaria. We conducted a hospital-based 28-day in vivo test comparing chloroquine/doxycycline to chloroquine or doxycycline alone for treating P. falciparum and Plasmodium vivax malaria in Irian Jaya, Indonesia. Eighty-nine patients with uncomplicated falciparum malaria were randomized to standard dose chloroquine (n = 30), doxycycline (100 mg every 12 hours [7 days], n = 20), or chloroquine with doxycycline (n = 39); corresponding numbers for vivax malaria (n = 63) were 23, 16, 24. Endpoints were parasite sensitivity (S) or resistance (RI/RII/RIII). Of the 105 evaluable patients, chloroquine/doxycycline cured (S) 20/22 (90.9% [95% CI 78.9-100%]) patients with P. falciparum malaria; 2/22 (9.1% [0-21%]) were RIII resistant. Doxycycline cured 11/17 (64.7% [42.0-87.4%]) patients, and chloroquine 4/20 (20% [2.5-37.5%]). Against P. vivax, chloroquine/doxycycline cured (S) 12/17 (70.6% [48.9-92.2%]) patients, doxycycline 4/12 (33.3% [6.6-59.9%]), and chloroquine 5/17 (29.4% [7.7-51.1%]). Chloroquine/doxycycline was effective against P. falciparum but only modestly effective against P. vivax. These findings support the use of chloroquine/doxycycline as an inexpensive alternative to mefloquine for treating chloroquine-resistant P. falciparum but not chloroquine-resistant P. vivax in this setting.
authors.affiliation: United States Naval Medical Research Unit Number 2, Jakarta, Indonesia.
authors.forename: W R
authors.initials: WR
authors.lastname: Taylor
authors.forename: H
authors.initials: H
authors.lastname: Widjaja
authors.forename: T L
authors.initials: TL
authors.lastname: Richie
authors.forename: H
authors.initials: H
authors.lastname: Basri
authors.forename: C
authors.initials: C
authors.lastname: Ohrt
authors.lastname: Tjitra
authors.forename: E
authors.initials: E
authors.lastname: Taufik
authors.forename: T R
authors.initials: TR
authors.lastname: Jones
authors.forename: K C
authors.initials: KC
authors.lastname: Kain
authors.forename: S L
authors.initials: SL
authors.lastname: Hoffman
mesh_terms: D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D002738:Chloroquine / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D004318:Doxycycline / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007214:Indonesia; D008288:Malaria / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D010966:Plasmodium vivax / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D002738:Chloroquine; D004318:Doxycycline