A Comparative Study of Gastrointestinal Infections in United States Soldiers Receiving Doxycycline or Mefloquine for Malaria Prophylaxis

James D. ArthurArmed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Peter EcheverriaArmed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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G. Dennis ShanksArmed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Jerome KarwackiArmed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Ladaporn BodhidattaArmed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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J. Edward BrownArmed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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A double blind study of daily doxycycline (100 mg) vs. weekly mefloquine (250 mg) was performed on United States soldiers training in Thailand to assess the effect of doxycycline malaria prophylaxis on the incidence of gastrointestinal infections. During a 5 week period, 49% (58/119) of soldiers receiving doxycycline and 48% (64/134) of soldiers receiving mefloquine reported an episode of diarrhea. Infection with bacterial enteric pathogens was identified in 39% (47/119) of soldiers taking doxcycline and 46% (62/134) of soldiers taking mefloquine. Forty-four percent (59/134) of soldiers receiving mefloquine and 36% (43/119) of soldiers receiving doxycycline were infected with enterotoxigenic Escherichia coli (ETEC), while 9% (12/134) of soldiers receiving mefloquine and 4% of soldiers receiving doxycycline were infected with Campylobacter. Side effects from either medication were minimal. After 5 weeks in Thailand, the percent of non-ETEC strains resistant to ≥2 antibiotics increased from 65% (77/119) to 86% (95/111) in soldiers on mefloquine and from 79% (84/106) to 93% (88/95) in soldiers on doxycycline. Doxycycline prophylaxis did not prevent or increase diarrheal disease in soldiers deployed to Thailand where ETEC and other bacterial pathogens are often resistant to tetracyclines.

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