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Doxycycline has antibacterial and anti-inflammatory effects. As an anti-bacterial medicine doxycycline is used to treat a wide range of infections caused by bacteria. It is commonly used by travellers to prevent malaria infection, being one of three antimalarial drugs used as a preventative against malaria. In some cases it is also used in combination with quinine to treat active malaria.

What does it do?

Doxycycline prevents malaria by killing the malaria parasite when it is in the blood stage of its life cycle. It also has some effect at the liver stage.

Who is at risk of malaria?

Malaria is endemic in some tropical and sub-tropical areas. The disease is spread by mosquitoes in infected areas of South America, Southern Asia, and Africa. Before travelling to these areas, it is important to check the risk of malaria for the specific location and time of year you are visiting. Consult the NHS Scotland Fit for Travel website or contact a travel clinic for advice on the recommended malaria tablet for different countries.

Why doxycycline?

Doxycycline is suitable as a malaria preventative for travel to high risk areas. It is prescribed after a medical consultation taking account of individual suitability, side effects, and possible adverse events. Doxycycline can be an attractive option because it is relatively low cost compared to other types of malaria tablets, and doesn't usually cause problems with side effects. It is a daily dosing regime, which may suit some people better than once a week.

Taking doxycycline for the first time

All medication should be taken as prescribed. Doxycycline to prevent malaria is taken at a dose of one 100mg capsule per day for adults and children over 12 (further information about malaria tablets for children). The course should begin 2 days before travel to a malaria zone, continuing throughout exposure to malaria, and then for 4 weeks afterwards. It is essential that the full course is completed.

Doxycycline should always be taken with food, preferably standing or sitting up, and preferably not just before lying down. It can cause acid reflux symptoms.

How effective is it?

Doxycycline is as effective as Lariam at preventing malaria infection, though no antimalarial is 100% effective. In addition to taking recommended malaria tablets, malaria risk can also be reduced by avoiding mosquito bites.

Possible side effects of doxycycline

All medicines have the potential to cause side-effects and reactions in some individuals.

Side effects from doxycycline can include gastrointestinal problems (such as nausea and diarrhoea), thrush, heartburn, and increased light sensitivity that can lead to sunburn.

A full list of the most frequent side effects can be found in the manufacturer's patient information leaflet supplied with doxycycline capsules.

Photosensitivity and doxycycline

Doxycycline can cause serious skin reactions to sunlight and increases the incidence of sunburn. Avoid sunbeds and direct sunlight, and use high-factor sunscreen.

When not to take doxycycline

During a consultation with Dr Fox adults will be asked to complete an online assessment questionnaire to determine suitability for antimalarial medication.

You should not take doxycycline without further consultation with your GP if you:

• Are pregnant or breastfeeding, or expect to be during your trip or for 4 weeks after.
• Have a sensitivity to tetracycline antibiotics.
• Have severe liver or kidney problems.
• Have a history of lupus, porphyria, or myasthenia gravis.
• Have problems with frequent diarrhoea.
• Are undergoing treatment for syphilis.

Doxycycline permanently discolours and damages developing teeth so should never be used beyond 15 weeks of pregnancy or in children up to age 12.

Other medications and doxycycline

Some medications interact with doxycycline and it should not be used whilst taking them.

These include:

• Warfarin or warfarin-type anticoagulants (where your blood thinning tablet dose is regularly monitored with blood tests).
• Quinapril (used to lower high blood pressure).
• Kaolin (used to treat diarrhoea).
• Penicillin or rifampicin (antibiotics).
• Sucralfate (used to treat and prevent stomach ulcers).
• Barbiturates (strong sleeping tablets, e.g. phenobarbital).
• Ergotamine (used to treat migraines or headaches).
• Typhoid vaccine oral capsules.
• Carbamazepine, phenytoin, primidone, or other drugs used to control epilepsy.
• Ciclosporin (used to affect the body's immune response following organ transplants).
• Methoxyflurane (an anaesthetic). If you need an operation, tell your doctor or dentist that you are taking doxycycline.
• Methotrexate (used to treat cancer, psoriasis, or rheumatoid arthritis).
• Medicines such as antacids (indigestion tablets or liquids) containing aluminium, calcium, magnesium, or other medicines containing iron, bismuth, or zinc salts.
• Retinoids, e.g. Roaccutane (used to treat various skin conditions).
• Lithium (used to moderate mood).

Other measures to prevent malaria

In addition to taking recommended malaria tablets, malaria risk can also be reduced by avoiding mosquito bites.

Mosquitoes can bite at any time of day. Most bites by malaria mosquitoes occur in the evening and overnight between dusk and dawn. In contrast, dengue fever mosquitoes tend to bite during the day.

• Wear long-sleeved clothing and long trousers if you are out at dusk, dawn, and at night. Several companies sell insect resistant travel clothing pre-treated with insecticide (permethrin).
• Use insect repellent containing DEET on exposed skin and under thin clothing, particularly around the ankles. The best strength DEET is 50% There is no added benefit to using higher concentrations. Other repellents containing picaridin 20% or lemon eucalyptus 30% are less effective than DEET and must be reapplied very frequently.
• Insect repellent room sprays, mosquito coils, and heating insecticide impregnated tablets all reduce the risk of bites and should be used to kill mosquitoes in bedrooms before going to bed.
• Where possible sleep in screened rooms and use a mosquito net, preferably one impregnated with insecticide (permethrin). Mosquitoes are deterred by air conditioning but not fans.

Ultrasound devices, mobile phone apps, garlic, Vitamin B, marmite, homeopathic products, tonic water, alcohol, tea tree oil, and citronella DO NOT prevent bites.

For further information see Travel Health Pro - Insect and tick bite avoidance and NHS - Malaria Prevention.

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Antibiotic guardianship

Doxycycline is an antibiotic (for infection) and also used as malaria prophylaxis. To combat antibiotic resistance please:

• Only use antibiotics when needed
• Never share antibiotics
• Always complete course as instructed
• Take unused medicine to local pharmacy for disposal

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