Filariasis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Overview

Different drugs are recommended for the treatment of filariasis depending on the specific causative pathogen.

Medical Therapy

Antimicrobial Regimen

• Filariasis

• 1. Lymphatic filariasis caused by Wuchereria bancrofti, Brugia malayi, Brugia timori

• Preferred regimen: Diethylcarbamazine 6 mg/kd/day PO tid for 12 days. Single dose of (DEC) has the same long-term effect in decreasing levels of microfilaria in blood as 12-day regimen. If patient is co-infected with onchocerciasis or loiasis DEC is contraindicated. DEC induces reversal of early lymphatic dysfunction in a patient with W.bancrofiti filariasis.
• Chronic cases: Regular exercise and leg elevation during night increase lymph flow. Physiotherapy may be effective in some cases. Regular washing of skin lesions and antibacterial oinntment are effective to prevent seconadry infection. Reconstructive surgery involving lymphatic-venous anastomoses have been attempted to improve lymphatic drainage, but the long-term benefit is still unclear. Hydrocele — The role of surgery depends upon the individual anatomy and local surgical expertise. Drainage of hydroceles may give some immediate relief but is almost always followed by reaccumulation of fluid. Hydrocelectomies can be helpful; among 301 patients with filariasis in Nigeria, hydrocelectomy was performed safely even in a rural area [63]. Chyluria — Chyluria may be associated with secondary nutritional deficiency. In such cases, low-fat, high-protein diets supplemented with medium-chain triglycerides can be helpful.

• 2. Loa loa filariasis

• 2.1 Symptomatic loiasis with < 8,000 microfilariae/mL

• Preferred regimen: Diethylcarbamazine 8–10 mg/kd/day PO tid for 21 days

• 2.2 Symptomatic loiasis, with < 8,000 microfilariae/mL and failed 2 rounds DEC

• Preferred regimen: Albendazole 200 mg PO bid for 21 days

• 2.3 Symptomatic loiasis, with ≥ 8,000 microfilariae/ml to suppress microfilaremia prior to treatment with DEC

• Preferred regimen: Albendazole 200 mg PO bid for 21 days

• 2.4 Symptomatic loiasis, with ≥ 8,000 microfilariae/mL

• Preferred regimen: Apheresis followed by Diethylcarbamazine
• Note: Apheresis should be performed at an institution with experience in using this therapeutic modality for loiasis.

• 3. River blindness (onchocerciasis) caused by Onchocerca volvulus

• Preferred regimen: Ivermectin 150 μg/kg PO single dose, repeated every 6-12 mos until asymptomatic
• Alternative regimen: Doxycycline 100 mg PO qd for 6 weeks, alone or followed by Ivermectin 150 μg/kg PO single dose
• Note: Do NOT administer Diethylcarbamazine where onchocerciasis is endemic due to increased risk for severe local inflammation in patients with ocular microfilariae.

• 4. Mansonella ozzardi

• Preferred regimen: Ivermectin 200 μg/kg PO single dose
• Note: Endosymbiotic Wolbachia are essential to filarial growth, development, embryogenesis and survival and represent an additional target for therapy. Doxycycline 100–200 mg PO qd for 6–8 weeks results in loss of Wolbachia and decrease in both micro- and macrofilariae.

• 5. Mansonella perstans

• Preferred regimen: Doxycycline 100–200 mg PO qd for 6–8 weeks

• 6. Mansonella streptocerca

• Preferred regimen (1): Diethylcarbamazine 6 mg/kd/day PO tid for 12 days
• Preferred regimen (2): Ivermectin 150 μg/kg PO single dose

• 7. Tropical pulmonary eosinophilia caused by Wuchereria bancrofti

• Preferred regimen: Diethylcarbamazine 6 mg/kd/day PO tid for 12–21 days

Guidelines and Resources

• WHO Preventive chemotherapy in human helminthiasis