Comparison of High Dose Ivermectin and Diethylcarbamazine for Activity Against Bancroftian Filariasis in Haiti

Frank O. Richards Jr. Division of Parasitic Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Hospital Saint Croix-Leogane, Boite Postale 2277, Atlanta, GA, Haiti

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Mark L. Eberhard Division of Parasitic Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Hospital Saint Croix-Leogane, Boite Postale 2277, Atlanta, GA, Haiti

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Ralph T. Bryan Division of Parasitic Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Hospital Saint Croix-Leogane, Boite Postale 2277, Atlanta, GA, Haiti

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David F. Mcneeley Division of Parasitic Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Hospital Saint Croix-Leogane, Boite Postale 2277, Atlanta, GA, Haiti

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Patrick J. Lammie Division of Parasitic Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Hospital Saint Croix-Leogane, Boite Postale 2277, Atlanta, GA, Haiti

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Marise B. Mcneeley Division of Parasitic Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Hospital Saint Croix-Leogane, Boite Postale 2277, Atlanta, GA, Haiti

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Yves Bernard Division of Parasitic Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Hospital Saint Croix-Leogane, Boite Postale 2277, Atlanta, GA, Haiti

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Allen W. Hightower Division of Parasitic Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Hospital Saint Croix-Leogane, Boite Postale 2277, Atlanta, GA, Haiti

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Harrison C. Spencer Division of Parasitic Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Hospital Saint Croix-Leogane, Boite Postale 2277, Atlanta, GA, Haiti

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DOI:
https://doi.org/10.4269/ajtmh.1991.44.3
Volume/Issue:
Volume 44: Issue 1
Page(s):
3–10
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This three-phase study was designed to compare high dose ivermectin with a standard diethylcarbamazine (DEC) regimen for patient tolerability, potential to kill adult filaria, and duration of microfilarial suppression in 30 Haitian subjects with Wuchereria bancrofti microfilaremia. All were first given a 1-mg oral dose of ivermectin (phase 1) to reduce microfilaria densities. Participants were randomized into three groups: Group 1 received DEC (6mg/kg per day for 12 days), Group 2 received 200 mcg/kg of ivermectin, and Group 3 received 400 mcg/kg of ivermectin (200 mcg/kg per day for 2 days). All drug regimens were well tolerated with few adverse reactions. Most reactions occurred during phase I and consisted primarily of headache, fever, and myalgia. At the end of phase 1, 27 of 30 (90%) patients were microfilaria negative. During phase 2, four of the six men receiving DEC developed scrotal reactions suggesting killing adult worms; no such reactions were noted in 10 men receiving ivermectin (p < 0.05). At one-year follow up (phase 3), all treatment groups had less than 10% return to pretreatment microfilaria levels. The mean percent of baseline microfilaria counts were for Group 1, 0.9% (range 0–5%); Group 2, 8.2% (range 0–31%); and Group 3, 3.8% (range 0–25%). Seven individuals in Group 1 were microfilaria-negative, while only one and three individuals were microfilaria-negative in Groups 2 and 3, respectively. These results suggest that DEC causes more damage to the adult worms and greater reduction in microfilaria densities than ivermectin, but that high doses of ivermectin may suppress microfilaremia in lymphatic filariasis for periods much longer than previously reported.
Copyright:
Copyright © 1991 by The American Society of Tropical Medicine and Hygiene 1991
Published Online:
Jan 1991
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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