Filariasis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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

Medical Therapy

Antimicrobial Regimen

  • 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 if patient will continue to live in endemic area or is younger than 9 years old)
  • 2. Loa loa filariasis
  • 2.1 Symptomatic loiasis with < 8,000 microfilariae/mL
  • 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 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/day PO 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 streptocerca
  • 5. Mansonella ozzardi
  • 6. Mansonella perstans

References

  1. "Drugs for Parasitic Infections (Treatment Guidelines from The Medical Letter)".
  2. Taylor MJ, Hoerauf A, Bockarie M (2010). "Lymphatic filariasis and onchocerciasis". Lancet. 376 (9747): 1175–85. doi:10.1016/S0140-6736(10)60586-7. PMID 20739055.
  3. Knopp S, Steinmann P, Hatz C, Keiser J, Utzinger J (2012). "Nematode infections: filariases". Infect Dis Clin North Am. 26 (2): 359–81. doi:10.1016/j.idc.2012.02.005. PMID 22632644.