Mefloquine versus doxycycline for malaria prophylaxis in intermittent exposure of Israeli Air Force aircrew in Rwanda

Abstract

Background: The issue of the best chemoprophylaxis agent for aircrew to use against malaria is still not settled.

Method: We studied the patterns of use of both doxycycline and mefloquine in aviators and other aircrew for 2 mo during biweekly flights from Israel to Rwanda with a few hours' visits. Some 28 aviators and 15 non-aviator aircrew were treated with doxycycline and mefloquine, respectively, less than 12 h before the first flight and up to 4 wk after the last return.

Results: No case of malaria occurred within or after the operational period. Compliance was better for mefloquine than for doxycyline for the full period of the operation (100% vs. 75%, respectively). The rate of side effects, mostly gastrointestinal, was higher for doxycycline (39% vs. 13%, respectively) and was related mainly to the frequency of administration (daily vs. weekly).

Conclusion: In situations involving frequent intermittent short-term visits to areas with substantial risk of acquiring malaria, we conclude that aircrew can safely take weekly mefloquine as prophylaxis.