RANDOMIZED, CONTROLLED, DOUBLE-BLIND TRIAL OF DAILY ORAL AZITHROMYCIN IN ADULTS FOR THE PROPHYLAXIS OF PLASMODIUM VIVAX MALARIA IN WESTERN THAILAND

D. GRAY HEPPNER JR. Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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DOUGLAS S. WALSH Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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NICHAPAT UTHAIMONGKOL Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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DOUGLAS B. TANG Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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SOMCHIT TULYAYON Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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BARNYEN PERMPANICH Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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THEERA WIMONWATTRAWATEE Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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NIPHON CHUANAK Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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ANINTITA LAOBOONCHAI Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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PRASIT SOOKTO Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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THOMAS G. BREWER Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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PHILIP MCDANIEL Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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CHIRAPA EAMSILA Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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KOSOL YONGVANITCHIT Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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KATHLEEN UHL Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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DENNIS E. KYLE Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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LISA W. KEEP Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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ROBERT E. MILLER Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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CHANSUDA WONGSRICHANALAI Department of Immunology and Medicine, United States Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi Province, Thailand; Research Division, Thai Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; United States Army Medical Materiel Development Activity, Fort Detrick, Frederick, Maryland

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We assessed the prophylactic efficacy of azithromycin (250 mg/day) against malaria in 276 adults in western Thailand in a randomized, double-blind, placebo-controlled trial. After antimalarial suppressive treatment, volunteers were randomized in a 2:1 ratio to either the azithromycin or placebo, respectively. Study medication was given for an average of 74 days. The azithromycin group (n = 179) had five endpoint parasitemias (1 Plasmodium vivax and 4 P. falciparum), and the placebo group (n = 97) had 28 endpoint parasitemias (21 P. vivax, 5 P. falciparum, and 2 mixed infections). Adverse events and compliance and withdrawal rates were similar in both groups. The protective efficacy (PE) of azithromycin was 98% for P. vivax (95% confidence interval [CI] = 88–100%). There were too few cases to reliably estimate the efficacy of azithromycin for P. falciparum (PE =71%, 95% C =−14–94%). We conclude that daily azithromycin was safe, well-tolerated, and had a high efficacy for the prevention of P. vivax malaria.

Author Notes

Reprint requests: D. Gray Heppner Jr., Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910.
  • 1

    Andersen SA, Ager AL, McGreevy P, Schuster BG, Ellis W, Berman JD, 1994. Efficacy of azithromycin as a causal prophylactic agent against murine malaria. Antimicrob Agents Chemother 38 :1862–1863.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Kuschner RA, Heppner DG, Andersen SL, Wellde BT, Hall T, Schneider I, Ballou WR, Foulds G, Sadoff JC, Schuster B, 1994. Azithromycin prophylaxis against a chloroquine-resistant strain of Plasmodium falciparum. Lancet 343 :1396–1397.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Anderson SL, Berman J, Kuschner R, Wesche D, Magill A, Wellde B, Schneider I, Dunne M, Schuster BG, 1995. Prophylaxis of Plasmodium falciparum malaria with azithromycin administered to volunteers. Ann Intern Med 123 :771–773.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Andersen SL, Oloo AJ, Gordon DM, Ragama OB, Aleman GM, Berman JD, Tang DB, Dunne MW, Shanks GD, 1998. Successful double-blinded, randomized, placebo-controlled field trial of azithromycin and doxycycline as prophylaxis for malaria in western Kenya. Clin Infect Dis 26 :146–150.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Taylor WR, Richie TL, Fryauff DJ, Picarima H, Ohrt C, Tang D, Braitman D, Murphy GS, Widjaja H, Tjitra E, Ganjar A, Jones TR, Basri H, Berman J, 1999. Malaria prophylaxis using azithromycin: a double-blind, placebo-controlled trial in Irian Jaya, Indonesia. Clin Infect Dis 28 :74–81.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Brockman A, Price RN, van Vugt M, Heppner DG, Walsh D, Sookto P, Wimonwattrawatee T, Looareesuwan S, White NJ, Nosten F, 2000. Plasmodium falciparum antimalarial drug susceptibility on the north-western border of Thailand during five years of extensive use of artesunate-mefloquine. Trans R Soc Trop Med Hyg 94 :537–544.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Wongsrichanalai C, Pickard AL, Wernsdorfer WH, Meshnick SR, 2002. Epidemiology of drug-resistant malaria. Lancet Infect Dis 2 :209–218.

  • 8

    van Vugt M, Looareesuwan S, Wilairatana P, 2000. Artemether-lumefantrine for the treatment of multidrug-resistant falciparum malaria. Trans R Soc Trop Med Hyg 94 :545–548.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Looareesuwan S, Wilairatana P, Krudsood S, Treeprasertsuk S, Singhasivanon P, Bussaratid V, Chokjindachai W, Viriyavejakul P, Chalermrut K, Walsh DS, White NJ, 1999. Chloroquine sensitivity of Plasmodium vivax in Thailand. Ann Trop Med Parasitol 93 :225–230.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Wongsrichanalai C, Murray CK, Gray M, Miller RS, McDaniel P, Liao WJ, Pickard AL, Magill AJ, 2003. Co-infection with malaria and leptospirosis. Am J Trop Med Hyg 68 :583–585.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Parola P, Miller RS, McDaniel P, Telford SR III, Rolain J-M, Wongsrichanalai C, Raoult D, 2003. Emerging rickettsioses of the Thai-Myanmar border. Emerg Infect Dis 9 :592–595.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Webster HK, Thaithong S, Pavanand K, Yongvanitchit K, Pinswasdi C, Boudreau EF, 1985. Cloning and characterization of mefloquine-resistant Plasmodium falciparum from Thailand. Am J Trop Med Hyg 34 :1022–1027.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Farrington CP, Manning G, 1990. Test statistics and sample size formulae for comparative binomial trials with null hypothesis of non-zero risk difference or non-unity relative risk. Stat Med 9 :1447–1454.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    World Health Organization, 1992. Methods for Field Trials for Interventions against Tropical Diseases. Geneva: United Nations Development Programme, World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases.

    • PubMed
    • Export Citation
  • 15

    Koopman PA, 1991. Confidence limits on the ratio of two proportions. Biometrics 40 :513–517.

  • 16

    Ederer F, Mantel N, 1974. Confidence limits on the ratio of two Poisson variables. Am J Epidemiol 100 :165–167.

  • 17

    Altman DG, 1991. Practical Statistics for Medical Research. New York: Chapman and Hall.

    • PubMed
    • Export Citation
  • 18

    Moher D, Schulz KF, Altman DG, 2001. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Lancet 357 :1191–1194.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Pukrittayakamee S, Clemens R, Chantra A, Nontprasert A, Luknam T, Looareesuwan S, White NJ, 2001. Therapeutic responses to antibacterial drugs in vivax malaria. Trans R Soc Trop Med Hyg 95 :524–528.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Ruuskanen O, 2004. Safety and tolerability of azithromycin in pediatric infectious diseases: 2003 update. Pediatr Infect Dis J 23 (Suppl 2):S135–S139.

  • 21

    Taylor WR, Richie TL, Fryauff DJ, Ohrt C, Picarima H, Tang D, Murphy GS, Widjaja H, Braitman D, Tjitra E, Ganjar A, Jones TR, Basri H, Berman J, 2003. Tolerability of azithromycin as malaria prophylaxis in adults in northeast Papua, Indonesia. Antimicrob Agents Chemother 47 :2199–2203.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Hughes WT, Dankner WM, Yogev R, Huang S, Paul ME, Flores MA, Kline MW, Wei LJ; Pediatric AIDS Clinical Trials Group 254 Team, 2005. Comparison of atovaquone and azithromycin with trimethoprim-sulfamethoxazole for the prevention of serious bacterial infections in children with HIV infection. Clin Infect Dis 40 :136–145.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Equi A, Balfour-Lynn IM, Bush A, Rosenthal M, 2002. Long term azithromycin in children with cystic fibrosis: a randomised, placebo-controlled crossover trial. Lancet 360 :978–984.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Shanks GD, Ragama OB, Aleman GM, Andersen SL, Gordon DM, 1996. Azithromycin prophylaxis prevents epidemic dysentery. Trans R Soc Trop Med Hyg 90 :316.

  • 25

    Nosten F, McGready R, Simpson JA, Thwai KL, Balkan S, Cho T, Hkirijaroen L, Looareesuwan S, White NJ, 1999. Effects of Plasmodium vivax malaria in pregnancy. Lancet 354 :546–549.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Ohrt C, Willingmyre GD, Lee P, Knirsch C, Milhous W, 2002. Assessment of azithromycin in combination with other anti-malarial drugs against Plasmodium falciparum in vitro. Antimicrob Agents Chemother 46 :2518–2524.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Dunne MW, Singh N, Shukla M, Valecha N, Bhattacharyya PC, Dev V, Patel K, Mohapatra MK, Lakhani J, Benner R, Lele C, Patki K, 2005. A multicenter study azithromycin, alone and in combination with chloroquine, for the treatment of acute uncomplicated Plasmodium falciparum malaria in India. J Infect Dis 191 :1582–1588.

    • PubMed
    • Search Google Scholar
    • Export Citation
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