Malaria Chemoprophylaxis using Proguanil/Dapsone Combinations on the Thai-Cambodian Border

G. Dennis Shanks Departments of Medicine and Immunology and Biochemistry, Armed Forces Research Institute of Medical Sciences (AFRIMS), Royal Thai Navy Medical Department, Bangkok, Thailand

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Michael D. Edstein Departments of Medicine and Immunology and Biochemistry, Armed Forces Research Institute of Medical Sciences (AFRIMS), Royal Thai Navy Medical Department, Bangkok, Thailand

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Varakorn Suriyamongkol Departments of Medicine and Immunology and Biochemistry, Armed Forces Research Institute of Medical Sciences (AFRIMS), Royal Thai Navy Medical Department, Bangkok, Thailand

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Somkid Timsaad Departments of Medicine and Immunology and Biochemistry, Armed Forces Research Institute of Medical Sciences (AFRIMS), Royal Thai Navy Medical Department, Bangkok, Thailand

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H. Kyle Webster Departments of Medicine and Immunology and Biochemistry, Armed Forces Research Institute of Medical Sciences (AFRIMS), Royal Thai Navy Medical Department, Bangkok, Thailand

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DOI:
https://doi.org/10.4269/ajtmh.1992.46.643
Volume/Issue:
Volume 46: Issue 6
Page(s):
643–648
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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.
Copyright:
Copyright © 1992 by The American Society of Tropical Medicine and Hygiene 1992
Published Online:
Jun 1992
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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