1921
Volume 70, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

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.

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2004-02-01
2017-11-24
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References

  1. Michael E, Bundy DA, Grenfell BT, 1996. Reassessing the global prevalence and distribution of lymphatic filariasis. Parasitology 112 : 409–428.
  2. Ottesen EA, Duke BO, Karam M, Behbehani K, 1997. Strategies and tools for the control/elimination of lymphatic filariasis. Bull World Health Organ 75 : 491–503.
  3. Ottesen EA, 2000. The global programme to eliminate lymphatic filariasis. Trop Med Int Health 5 : 591–594.
  4. Molyneux D, Neira M, Liese B, Heymann D, 2001. Elimination of lymphatic filariasis as a public health problem: setting the scene for elimination. Trans R Soc Trop Med Hyg 94 : 589–591.
  5. Bockarie MJ, Tisch DJ, Kastens W, Alexander ND, Dimber Z, Bockarie F, Ibam E, Alpers MP, Kazura JW, 2002. Mass treatment to eliminate lymphatic filariasis in Papua New Guinea. N Engl J Med 347 : 1841–1848.
  6. Ottesen EA, Ismail MM, Horton J, 1999. The role of albendazole in programmes to eliminate lymphatic filariasis. Parasitol Today 15 : 382–386.
  7. Horton J, Witt C, Ottesen EA, Lazdins JK, Addiss DG, Awadzi K, Beach MJ, Belizario VY, Dunyo SK, 2000. An analysis of the safety of the single dose, two drug regimens used in programmes to eliminate lymphatic filariasis. Parasitology 121 : S147–S160.
  8. Ismail MM, Jayakody RL, Weil GJ, Nirmalan N, Jayasinghe KSA, Abeyewickrema W, Sheriff MHR, Rajaratnam HN, Amarasekera N, deSilva DCL, Michalski ML, Dissanaike AS, 1998. Efficacy of single dose combinations of albendazole, ivermectin, and diethylcarbamazine for the treatment of bancroftian filariasis. Trans R Soc Trop Med Hyg 92 : 94–97.
  9. Ismail MM, Jayakody RL, Weil GJ, Fernando D, DeSilva MSG, Balasooriya WK, 2001. Long-term efficacy of single-dose combinations of albendazole, ivermectin, and diethylcarbamazine for the treatment of lymphatic filariasis. Trans R Soc Trop Med Hyg 95 : 332–335.
  10. Farid HA, Hammad RE, Soliman DA, El-Setouhy M, Ramzy RMR, Weil GJ, 2003. Relationships between Wuchereria bancrofti microfilaria counts in human blood and parasite uptake and maturation in Culex pipiens, with observations on the effect of diethylcarbamazine treatment on these parameters. Am J Trop Med Hyg 68 : 286–293.
  11. Norman RA, Chan MS, Srividya A, Pani SP, Ramaiah KD, Vanamail P, Michael E, Das PK, Bundy DAP, 2000. EPIFIL: The development of an age-structured model for describing the transmission dynamics and control of lymphatic filariasis. Epidemiol Infect 124 : 529–541.
  12. Ramaiah KD, Das PK, Appavoo NC, Ramu K, Augustin DJ, Kumar KNV, Chandrakala AV, 2000. A programme to eliminate lymphatic filariasis in Tamil Nadu state, India: compliance with annual single-dose DEC mass treatment and some related operational aspects. Trop Med Int Health 5 : 842–847.
  13. Das PK, Ramaiah KD, Vanamail P, Pani SP, Yuvaraj J, Blalrajan K, Bundy DAP, 2001. Placebo-controlled community trial of four cycles of single-dose diethylcarbamazine or ivermectin against Wuchereria bancrofti infection and transmission in India. Trans R Soc Trop Med Hyg 95 : 331–336.
  14. World Health Organization, 2000. Preparing and Implementing a National Plan to Eliminate Lymphatic Filariasis in Countries Where Onchocerciasis Is Not Coendemic. Document WHO/ CDS/CPE/CEE/2000.
  15. Geneva: World Health Organization. 15. Weil GJ, Lammie PJ, Weiss N, 1997. The ICT Filariasis Test: a rapid-format antigen test for diagnosis of bancroftian filariasis. Parasitol Today 13 : 401–404.
  16. Faris R, Hussain O, El-Setouhy M, Ramzy RM, Weil GJ, 1998. Bancroftian filariasis in Egypt: Visualization of adult worms and subclinical lymphatic pathology by scrotal ultrasound. Am J Trop Med Hyg 59 : 864–867.
  17. Noroes J, Dreyer G, Santos A, Mendes VG, Medeiros Z, Addiss D, 1997. Assessment of the effect of diethylcarbamazine on adult Wuchereria bancrofti in vivo. Trans R Soc Trop Med Hyg 91 : 78–81.
  18. Weil GJ, Ramzy RMR, El-Setouhy M, Kandil AM, Ahmed ES, Faris R, 1999. A longitudinal study of bancroftian filariasis in the Nile delta of Egypt: baseline data and one year follow-up. Am J Trop Med Hyg 61 : 53–58.
  19. National Cancer Institute, 1999. Cancer Therapy Evaluation Program: Common Toxicity Criteria Document, Version 2.0.
  20. Littell RC, Milikin GA, Stroup WW, Wolfinger RD, 1996. SAS System For Mixed Models. Cary, NC: SAS Institute.
  21. Shenoy RK, John A, Babu BS, Suma TK, Kumaraswami V, 2000. Two-year follow-up of the microfilaraemia of asymptomatic brugian filariasis, after treatment with two, annual, single doses of ivermectin, diethylcarbamazine, and albendazole, in various combinations. Ann Trop Med Parasitol 94 : 607–614.
  22. Ismail MM, Weil GJ, Jayasinghe KS, Premaratne UN, Abeyewickrema W, Rajaratnam HN, Sheriff MH, Perera CS, Dissanaike AS, 1996. Prolonged clearance of microfilaremia after multiple high doses of ivermectin or diethylcarbamazine. Trans R Soc Trop Med Hyg 90 : 684–688.
  23. Freedman DO, Plier DA, de Almeida AB, de Oliveira AL, Miranda J, Braga C, 2001. Effect of aggressive prolonged diethylcarbamazine therapy on circulating antigen levels in bancroftian filariasis. Trop Med Int Health 6 : 37–41.
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  • Received : 02 Jul 2003
  • Accepted : 08 Sep 2003

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