A double-blind, placebo-controlled study of the efficacy of oral penicillin, diethylcarbamazine or local treatment of the affected limb in preventing acute adenolymphangitis in lymphoedema caused by brugian filariasis

Abstract

Acute attacks of adenolymphangitis (ADL) contribute significantly to the morbidity seen in cases of filarial lymphoedema. Such cases are now being treated with multiple courses of the antifilarial drug diethylcarbamazine (DEC), either alone or in combination with antibiotics or anti-inflammatory drugs, based on anecdotal experience. In this, the first double-blind, placebo-controlled study, 150 patients with lymphoedema caused by brugian filariasis, each of whom recalled two or more ADL attacks in the previous year, were enrolled on a comprehensive foot-care programme. Each was also randomly allocated to one of the following five daily regimens (30 patients/regimen) for 1 year: 800 mg oral penicillin; 1 mg DEC/kg; 800 mg oral penicillin plus 1 mg DEC/kg; local antibiotics; or placebo. Each patient was followed up for another year. For each regimen group (including the placebo group), the number of ADL attacks in the treatment year was significantly less than that in the year prior to treatment (P < 0.001). Although, in all but the placebo group, there was a slight increase in the number of episodes in the follow-up year compared with the treatment year, the increase was only significant in the two groups given penicillin. Of all the treatments tested therefore, foot care seems to play the most important role in the prevention of ADL attacks. Additional benefit may accrue from local or systemic antibiotic use in those with high grades of oedema, but antifilarials have no place in the prevention of ADL attacks in an individual patient. These observations should help in the rational management and prevention of ADL attacks in filarial lymphoedema, so that the progression of the disease may be halted and morbidity reduced.

Impact of a Community-Based Lymphedema Management Program on Episodes of Adenolymphangitis (ADLA) and Lymphedema Progression - Odisha State, India

“…The rate of ADLA was lowest six months after enrollment, yet a decrease was sustained over the two year period of the study. These findings are consistent with other studies which have also found a decrease in ADLA episodes following enrollment in a lymphedema management program [2], [3], [13], [14], [23], [24]. Other programs have found a similar plateauing of the ADLA rate 3–12 months after beginning lymphedema management [13], [14].…”

“…Persons with lymphatic dysfunction caused by LF may suffer from adenolymphangitis (ADLA) episodes characterized by swelling, inflammation of the limbs, fever, malaise and chills [1]. The frequency of ADLA episodes has been shown to increase with more advanced lymphedema and studies have concluded that ADLA episodes are a risk factor for lymphedema progression [2]–[6].…”

Feasibility and Effectiveness of Basic Lymphedema Management in Leogane, Haiti, an Area Endemic for Bancroftian Filariasis

“…Recent studies indicate that, in addition to being a critical risk factor for progression of lymphedema [4]–[8], [13], [14], ADLA episodes are strongly associated with poor quality of life [10], [22]–[28]. Thus, reducing ADLA frequency is arguably the most important objective of lymphedema management in resource-poor countries.…”

Doxycycline Improves Filarial Lymphedema Independent of Active Filarial Infection: A Randomized Controlled Trial

“…Measurements were performed at 10 cm from the large toe and 12, 20, and 30 cm from the sole of the foot, as described elsewhere [10, 11]. Averages of the 4 measurements were determined before treatment and at follow-up.…”