Ivermectin for the treatment of periodic malayan filariasis: a study of efficacy and side effects following a single oral dose and retreatment at six months

Acute attacks of adenolymphangitis (ADL) not only force patients with lymphatic filariasis to seek medical attention but also hasten the progression of filarial oedema. Patients with filariasis-associated ADL are currently treated with repeated courses of the antifilarial drug diethylcarbamazine (DEC), with or without antibiotics and anti-inflammatory agents. In this double-blind, placebo-controlled study, the efficacy of local treatment of the affected limb combined with repeated doses of ivermectin or DEC, in preventing the occurrence of ADL in Brugia malayi lymphatic filariasis, was examined. Overall, 120 patients who had each had at least two ADL attacks in the previous year were each admitted to the study at the time of an ongoing episode of ADL. The patients were randomly allocated to receive 12, monthly treatments of ivermectin (400 micrograms/kg), DEC (10 mg/kg) or placebo, in addition to local care of the affected limbs. There was a significant reduction in the frequency of ADL attacks in each of the three groups during the 2-year study period (P < 0.001 for each comparison). Most importantly, there were no significant differences in frequency of attacks between the three groups, either at the end of the treatment phase or at the end of the post-treatment phase (P > 0.15 for each comparison), suggesting that foot care combined with appropriate use of local antibiotics or antifungals is adequate to reduce the number of ADL attacks. The implications of these observations for planning morbidity control in lymphatic filariasis are discussed.

mentioning

confidence: 99%

Prevention of acute adenolymphangitis in brugian filariasis: comparison of the efficacy of ivermectin and diethylcarbamazine, each combined with local treatment of the affected limb

Shenoy

Suma

Rajan

et al. 1998

“…There are important differences between the responses of bancroftian and brugian infections when treated with the old drug DEC, the new drug ivermectin, combinations of these two drugs, or DEC-forti® ed salt (Shenoy et al, 1992(Shenoy et al, , 1993(Shenoy et al, , 1998a. The failure of ultrasonography to demonstrate the adult worm s of B. malayi deprives investigators of an opportunity to study the differences in the response of adult B. malayi and adult W. bancrofti to drug treatment in vivo.…”

Section: Discussionmentioning

confidence: 99%

Apparent failure of ultrasonography to detect adult worms of Brugia malayi

Shenoy

John²,

Hameed³

et al. 2000

Adult worms of Wuchereria bancrofti, or rather their characteristic movements (the 'filarial dance'), can now be detected in the scrotal lymphatics of microfilaraemic males, using ultrasonography. This ability has been used to delineate the lymphatic pathology of bancroftian filariasis, guide the surgical removal of the adult worms and, most importantly, assess the macrofilaricidal effects of antifilarial drugs. In the present study, the first report of the use of ultrasonography in brugian filariasis, 22 men (aged 18-62 years) with 60-2972 (median = 370) Brugia malayi microfilariae/ml blood were subjected to ultrasonography using a linear, 7.5-MHz probe. In addition, four other men (aged 19-35 years), with W. bancrofti microfilaraemia [28-524 (median = 234) microfilariae/ml], were similarly examined. Adult worms were not detectable in any of the patients with B. malayi parasitaemia but were detected in the scrotal lymphatics of two of the four individuals with W. bancrofti infection. The reasons for the failure to detect adult B. malayi and the limitations of ultrasound as a screening tool are examined. The results highlight the differences between the two species that cause most lymphatic filariasis and the need for rapid development of tools that can be used for the control of brugian lymphatic filariasis.

“…Medical College Hospital, Alleppey, for a total period of 7 days: 2 days pretreatment for baseline evaluation and 5 days post-treatment. All were evaluated pre-treatment (Shenoy et al, 1992(Shenoy et al, , 1993, each being given a complete physical examination and subjected to haematological tests (com plete blood counts, haematocrit, total and differential white cell counts), biochem ical tests (bilurubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and creatinine levels), urinalysis, chest X-rays and electrocardiography. Vital signs and clinical signs were recorded every 4 h for the ® rst 48 h post-treatment and daily for the remaining part of the hospital stay.…”

Section: Clinical Evaluationmentioning

confidence: 99%

“…A total reaction score was generated for each subject by summing all the scores recorded for his clinical side-effects during the hospitalphase of the study (Shenoy et al, 1992(Shenoy et al, , 1993.…”

Section: Evaluation Of Side-effectsmentioning

confidence: 99%

“…The ef® cacy and safety of single doses of iverm ectin (20± 200 m g/kg) in the treatment of micro® laraemias due to Brugia malayi have been the subject of a dose-® nding study (Shenoy et al, 1992). Although the results of a double-blind, controlled trial by Shenoy et al (1993) failed to show any advantage in splitting the dose of either DEC (1± 7 mg/kg) or ivermectin (20± 420 m g/kg) in terms of ef® cacy or tolerability, it did indicate that a single dose of ivermectin had similar effects on micro® larial levels 1 year post-treatment to those of a single dose of DEC.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Treatment of microfilaraemia in asymptomatic brugian filariasis: the efficacy and safety of the combination of single doses of ivermectin and diethylcarbamazine

K¹

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 micrograms/kg) and DEC (6 mg/kg) as a single treatment. Twelve hours post-treatment, 96.5%-100% of the microfilariae 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 was 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.