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The Global Program for Elimination of Lymphatic Filariasis calls for mass drug administration for endemic populations outside of sub-Saharan Africa with a single dose of diethylcarbamazine (DEC) and albendazole (Alb) annually for 4–6 years. Single-dose DEC/Alb dramatically reduces blood microfilaria (MF) counts, but most treated subjects fail to completely clear MF after a single dose. A more effective regimen might reduce the number of years required for elimination programs. We performed a randomized clinical trial in Egyptian adults with asymptomatic microfilaremia to compare treatment with seven daily doses of oral DEC (6 mg/kg) and Alb (400 mg) with a single dose of the same combination. We also studied the effect of re-treatment with single-dose DEC/Alb 12 months after the first treatment course. Multi-dose DEC/Alb was significantly more effective than single-dose therapy for reducing and clearing microfilaremia (mean reduction in MF/ml relative to pretreatment counts at 12 months, 99.6% versus 85.7%, with complete clearance in 75% versus 23.1%). The two regimens had similar activity against adult filarial worms, as indicated by serial ultrasound assessments. Neither regimen resulted in complete clearance of filarial antigenemia. There was no difference in adverse events, which were mild to moderate. Blood microfilaria and parasite antigen clearance rates increased following re-treatment. Multi-dose DEC/Alb may be a useful option for filariasis elimination programs, especially in the first year (when enthusiasm for mass drug administration and coverage rates are high), to quickly reduce community MF loads and transmission rates.
Received July 2, 2003. Accepted for publication September 8, 2003.
Acknowledgments: We are grateful for technical assistance provided by the field research teams and laboratory staff at the Research and Training Center on Vectors of Diseases at Ain Shams University. The late Professor Rifky Faris helped to plan this study. Dr. William Shannon at Washington University provided expert statistical assistance.
Disclosure: The authors wish to disclose that the AMRAD ICT filariasis test used in this study employs materials licensed from Barnes-Jewish Hospital. This information is provided in the interest of full disclosure and not because the authors consider this to be a conflict of interest.
Financial support: This work was supported by National Institutes of Health grant AI-35855.
Authors’ addresses: Maged El Setouhy and Omar Hussain, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt, Telephone: 20-2-6853276, Fax: 20-2-4837888. Reda M. R. Ramzy, Ehab S. Ahmed, Amr M. Kandil, Hoda A. Farid, and Hanan Helmy, Research and Training Center on Vectors of Diseases, Faculty of Science Building, Ain Shams University, Abbassia, Cairo 11566, Egypt, Telephone and Fax: 20-2-683-9622. Gary J. Weil, Infectious Diseases Division, Box 8051, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, Telephone: 314-454-7782, Fax: 314-454-5293, E-mail: gweil{at}im.wustl.edu.
Reprint requests: Gary J. Weil, Infectious Diseases Division, Box 8051, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110.
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