Treatment of bancroftian filariasis in Recife, Brazil: a two-year comparative study of the efficacy of single treatments with ivermectin or diethylcarbamazine

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 89; no. 1; pp. 98 - 102
• Main Authors: Dreyer, Gerusa, Coutinho, Amaury, Miranda, Democrito, Noroes, Joaquim, Rizzo, Jose Angelo, Galdino, Eliane, Rocha, Abraham, Medeiros, Zulma, Andrade, Luiz D., Santos, Abiel, Figueredo-Silva, Jose, Ottesen, Eric A.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 1995; Royal Society of Tropical Medicine and Hygiene; Elsevier
• Subjects: Administration, Oral; Adolescent; Adult; Biological and medical sciences; Brazil; diethylcarbamazine; Diethylcarbamazine - administration & dosage; Diethylcarbamazine - adverse effects; Diseases caused by nematodes; Double-Blind Method; Drug Therapy, Combination; Elephantiasis, Filarial - drug therapy; Filariases; filariasis; Helminthic diseases; Humans; Infectious diseases; ivermectin; Ivermectin - administration & dosage; Ivermectin - adverse effects; Male; Medical sciences; Miscellaneous; Parasitic diseases; Treatment Outcome; Tropical medicine; Wuchereria bancrofti; South America; Brazil; America; Brazil; Wuchereria bancrofti; ivermectin; filariasis; diethylcarbamazine; Human; Anthelmintic; Treatment efficiency; Microfilaria; Parasitosis; Helminthiasis; Infection; Chemotherapy; Treatment; Nematod disease; Helmintha; Nemathelminthia; Filariosis; Invertebrata; Nematoda; Comparative study; Ivermectin
• DOI: 10.1016/0035-9203(95)90674-6
• ISSN: 0035-9203

The effectiveness of single oral doses of ivermectin (200 or 400 (μg/kg) and diethylcarbamazine (DEC, 6 mg/kg), preceded 4 d earlier by either placebo or very small doses of these drugs, was compared, over a 2-year period, in a double-blind trial in 67 microfilaraemic Brazilian men with bancroftian filariasis. Regimens containing ivermectin alone decreased the number of microfilariae significantly faster and more effectively for the first month after treatment than regimens containing DEC alone, but the latter were significantly more effective throughout the second year after treatment (1.7–8.2% of pretreatment levels with DEC vs. 12.6–30.8% with ivermectin during that period); the higher ivermectin dose showed a tendency towards more effectiveness than the lower dose. Most effective was the combination of ivermectin (20 μg/kg) followed 4 d later by DEC (6 mg/kg), with reduction of microfilaraemia to 2.4% of pretreatment levels at 2 years. Adverse reactions were well tolerated with all regimens, the reactions being significantly more generalized (i.e., fever) following ivermectin and localized (i.e., scrotal inflammatory nodules around dying adult worms) following DEC. Further trials of single-dose combination therapy vs. single high doses of ivermectin or DEC should determine the ideal regimen for treatment and control of bancroftian filariasis.