The end of a dogma: the safety of doxycycline use in young children for malaria treatment

Abstract

Anti-malarial drug resistance to chloroquine and sulfadoxine–pyrimethamine has spread from Southeast Asia to Africa. Furthermore, the recent emergence of resistance to artemisinin-based combination therapy (ACT) in Southeast Asia highlights the need to identify new anti-malarial drugs. Doxycycline is recommended for malaria chemoprophylaxis for travel in endemic areas, or in combination with the use of quinine for malaria treatment when ACT is unavailable or when the treatment of severe malaria with artesunate fails. However, doxycycline is not used in young children under 8 years of age due to its contraindication due to the risk of yellow tooth discolouration and dental enamel hypoplasia. Doxycycline was developed after tetracycline and was labelled with the same side-effects as the earlier tetracyclines. However, recent studies report little or no effects of doxycycline on tooth staining or dental enamel hypoplasia in children under 8 years of age. In the United States, the Centers for Disease Control and Prevention have recommended the use of doxycycline for the treatment of acute and chronic Q fever and tick-borne rickettsial diseases in young children. It is time to rehabilitate doxycycline and to recommend it for malaria treatment in children under 8 years of age.

Randomized, Double-Blind, Placebo-Controlled Studies to Assess Safety and Prophylactic Efficacy of Naphthoquine-Azithromycin Combination for Malaria Prophylaxis in Southeast Asia

“…Because Malarone and doxycycline require daily administration for malaria prevention, compliance is a problem (9). In addition, doxycycline is contraindicated in pregnant women and younger children, and it is also associated with phototoxicity (10,11). Mefloquine is not recommended in some Southeast Asian countries where mefloquine resistance has emerged, and it is not recommended for pregnant women, infants, and persons with neuropsychiatric disorders (12).…”

Evidence of pathogenic zoonotic tick-borne Rickettsia and Borrelia spp. in some communal farms in the Eastern Cape Province, South Africa

“…In addition, human cases of R. mongolotimonae have recently been reported in Sri Lanka from a 30-yearold female who returned from travelling to a jungle and was examined as an outpatient for fever [57] and also in Cameroon, from a 54-year-old woman who presented a clinical symptoms of fever, headache, chills, myalgia and arthralgia [58]. Generally, R. mongolitimonae infection has been described to cause a mild, less fatal disease, nevertheless some complications have been reported, such as disseminated intravascular coagulation, shock, neurological disorders, atrial brillation, retinal vasculitis and acute renal failure [59].…”

Evidence of pathogenic zoonotic tick-borne Rickettsia and Borrelia spp.  in some communal farms in the Eastern Cape Province, South Africa

“…In addition, human cases of R. mongolotimonae have recently been reported in Sri Lanka from a 30year-old female who returned from travelling to a jungle and was examined as an outpatient for fever 66 and also in Cameroon, from a 54-year-old woman who presented a clinical symptoms of fever, headache, chills, myalgia and arthralgia 67 . Generally, R. mongolitimonae infection has been described to cause a mild, less fatal disease, nevertheless some complications have been reported, such as disseminated intravascular coagulation, shock, neurological disorders, atrial fibrillation, retinal vasculitis and acute renal failure 68 .…”