Malaria Prophylaxis Using Azithromycin: A Double-Blind, Placebo-Controlled Trial in Irian Jaya, Indonesia

New drugs are needed for preventing drug-resistant Plasmodium falciparum malaria. The prophylactic efficacy of azithromycin against P. falciparum in malaria-immune Kenyans was 83%. We conducted a double-blind, placebo-controlled trial to determine the prophylactic efficacy of azithromycin against mu...

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Bibliographic Details
Published in:Clinical infectious diseases 1999-01, Vol.28 (1), p.74-81
Main Authors: Taylor, Walter R. J., Richie, Thomas L., Fryauff, David J., Picarima, Helena, Ohrt, Colin, Tang, Douglas, Braitman, David, Murphy, Gerald S., Widjaja, Hendra, Tjitra, Emiliana, Ganjar, Asep, Jones, Trevor R., Basri, Hasan, Berman, Josh
Format: Article
Language:English
Subjects:
Adolescent
Adult
Animals
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Antibiotic Prophylaxis
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antimalarials
Antimalarials - therapeutic use
Antiparasitic agents
Azithromycin - therapeutic use
Biological and medical sciences
Civilian personnel
Clinical Articles
Dosage
Double-Blind Method
Doxycycline - pharmacology
Drug tolerance
Falciparum malaria
Female
Human protozoal diseases
Humans
Indonesia
Infectious diseases
Malaria
Malaria, Falciparum - epidemiology
Malaria, Falciparum - prevention & control
Malaria, Vivax - epidemiology
Malaria, Vivax - prevention & control
Male
Medical sciences
Middle Aged
Parasitemia
Parasitemia - parasitology
Parasitic diseases
Pharmacology. Drug treatments
Placebos
Protozoal diseases
Soldiers
Treatment Outcome
Tropical medicine
Vivax malaria
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Summary:New drugs are needed for preventing drug-resistant Plasmodium falciparum malaria. The prophylactic efficacy of azithromycin against P. falciparum in malaria-immune Kenyans was 83%. We conducted a double-blind, placebo-controlled trial to determine the prophylactic efficacy of azithromycin against multidrug-resistant P. falciparum malaria and chloroquine-resistant Plasmodium vivax malaria in Indonesian adults with limited immunity. After radical cure therapy, 300 randomized subjects received azithromycin (148 subjects, 750-mg loading dose followed by 250 mg/d), placebo (77), or doxycycline (75, 100 mg/d). The end point was slide-proven parasitemia. There were 58 P. falciparum and 29 P. vivax prophylaxis failures over 20 weeks. Using incidence rates, the protective efficacy of azithromycin relative to placebo was 71.6% (95% confidence interval [CI], 50.3–83.8) against P. falciparum malaria and 98.9% (95% CI, 93.1–99.9) against P. vivax malaria. Corresponding figures for doxycycline were 96.3% (95% CI, 85.4–99.6) and 98% (95% CI, 88.0–99.9), respectively. Daily azithromycin offered excellent protection against P. vivax malaria but modest protection against P. falciparum malaria.
ISSN:1058-4838
1537-6591
DOI:10.1086/515071