{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T18:16:36Z","timestamp":1783188996857,"version":"3.54.6"},"reference-count":74,"publisher":"Oxford University Press (OUP)","issue":"7-8","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Military and other specialist personnel may be exposed to malaria during deployment. Doxycycline is a frequently prescribed malarial chemoprophylaxis, but its use is associated with gastrointestinal adverse effects. The aim was to investigate the association between extended use of doxycycline malarial chemoprophylaxis within a military population and the development of GI conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a systematic search of academic databases was undertaken. Dedicated inclusion and exclusion eligibility criteria were applied to ensure only studies meeting the research intent were retained. Remaining studies were assessed for study quality using Critical Appraisal Skills Programme (CASP) appraisal tools. The study protocol was registered with the Open Science Framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven studies randomized control field trials (RCTs), n\u2009=\u20093: retrospective quantitative (mainly) survey-based studies n\u2009=\u20098) from seven different countries, meet the eligibility criteria. Reports of adverse GI effects (n\u2009=\u20092322) were recorded representing between 3% and 79% (median 39%) of participants across the studies. RCTs CASP appraisal results were generally higher (high quality) as compared to the survey-based studies (moderate quality). The unique focus of this systematic review enabled scrutinization of the frequency, severity and potential risk to long term health of extended doxycycline use for currently serving and veteran population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Within the population studied, doxycycline chemoprophylaxis is frequently associated with a range of GI-related adverse effects from mild to severe and chronic conditions which, with extended use, have the potential to impact long-term health and quality of life. Pragmatic recommendations targeted to military and veteran organizations aim to minimize some adverse outcomes. Large-scale, longitudinal studies are needed to more accurately establish the risk profile of extended doxycycline use for malarial prophylaxis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usaf517","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T12:00:53Z","timestamp":1760097653000},"page":"e1400-e1409","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Doxycycline Chemoprophylaxis and the Development of Gastrointestinal Conditions in Military Personnel: A Systematic Review"],"prefix":"10.1093","volume":"191","author":[{"given":"Matthew","family":"Olsen","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences and Medicine, Bond University , Robina, QLD 4226,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwame Peprah","family":"Boaitey","sequence":"additional","affiliation":[{"name":"Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University , Robina, QLD 4226,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Orr","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Medicine, Bond University , Robina, QLD 4226,","place":["Australia"]},{"name":"Tactical Research Unit, Faculty of Health Sciences and Medicine, Bond University , Robina, QLD 4226,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan James","family":"Rudzki","sequence":"additional","affiliation":[{"name":"Canberra Sports Medicine , Deakin, A.C.T., 2600,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3618-1208","authenticated-orcid":false,"given":"Anna","family":"Lohning","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Medicine, Bond University , Robina, QLD 4226,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,1]]},"reference":[{"key":"2026070413271126000_usaf517-B1","author":"Organization WH","year":"2023"},{"key":"2026070413271126000_usaf517-B2","doi-asserted-by":"publisher","first-page":"e2012045","DOI":"10.4084\/MJHID.2012.45","article-title":"Prophylaxis of malaria","volume":"4","author":"Schwartz","year":"2012","journal-title":"Mediterr J Hematol Infect Dis"},{"key":"2026070413271126000_usaf517-B3","doi-asserted-by":"publisher","first-page":"517","DOI":"10.4269\/ajtmh.2011.10-0285","article-title":"Doxycycline for malaria chemoprophylaxis and treatment: Report from the CDC expert meeting on malaria chemoprophylaxis","volume":"84","author":"Tan","year":"2011","journal-title":"Am J Trop Med Hyg"},{"key":"2026070413271126000_usaf517-B4","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1086\/516281","article-title":"Successful double-blinded, randomized, placebo-controlled field trial of azithromycin and doxycycline as prophylaxis for malaria in Western Kenya","volume":"26","author":"Andersen","year":"1998","journal-title":"Clin Infect Dis"},{"key":"2026070413271126000_usaf517-B5","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1086\/515071","article-title":"Malaria prophylaxis using azithromycin: a double-blind, placebo-controlled trial in irian jaya, Indonesia","volume":"28","author":"Taylor","year":"1999","journal-title":"Clin Infect Dis"},{"key":"2026070413271126000_usaf517-B6","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1093\/infdis\/171.6.1569","article-title":"Daily primaquine is effective for prophylaxis against falciparum malaria in Kenya: comparison with mefloquine, doxycycline, and chloroquine plus proguanil","volume":"171","author":"Weiss","year":"1995","journal-title":"J Infect Dis"},{"key":"2026070413271126000_usaf517-B7","doi-asserted-by":"publisher","first-page":"963","DOI":"10.7326\/0003-4819-126-12-199706150-00006","article-title":"Mefloquine compared with doxycycline for the prophylaxis of malaria in indonesian soldiers. 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