Treatment of microfilaraemia in asymptomatic brugian filariasis: the efficacy and safety of the combination of single doses of ivermectin and diethylcarbamazine
1998
Although combinations of ivermectin and diethylcarbamazine (DEC) have been shown to be superior to
either drug alone in the suppression of bancroftian microfilariae, their efficacy against infections with
Brugia malayi has never been investigated. The present, open trial is the first on the efficacy and safety
of a combination of single doses of ivermectin and DEC when used against microfilaraemias of brugian
filariasis. Twenty-one, asymptomatic but microfilaraemic (109-6934 microfilariae/ml blood, with a median
of 841/ml) men, aged 18-48 years, each received oral doses of ivermectin (400 μg/kg) and DEC (6 mg/kg)
as a single treatment. Twelve hours post-treatment, 96.5%-100% of the microflariae in each subject had
been cleared and 12 of the subjects were amicrofilaraemic. A further reduction in microfilarial counts was
evident 1 month post-treatment (mean clearance = 99.0%) and the counts continued to fall at least until
the last follow-up, at 1 year post-treatment, when the mean clearance has 99.9 % and 13 (68.4%) of the
19 subjects then investigated were amicrofilaraemic. All subjects experienced adverse reactions of one form
or another, lasting for up to 48 h post-treatment; these included fever, myalgia, headache, and lethargy.
Postural hypotension was recorded in two subjects and dilated, inflamed lymphatic channels were seen in
another two.
The combination of ivermectin and DEC demonstrated a microfilaricidal effect superior to that of either
drug used alone, both in the initial rapid clearance of microfilariae and in sustaining the effect for 1 year.
This finding has important implications for the control of lymphatic filariasis.
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