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[4]
- 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 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 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
References
- ↑ "Drugs for Parasitic Infections (Treatment Guidelines from The Medical Letter)".
- ↑ 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.
- ↑ 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.
- ↑ "Parasites - Loiasis (CDC)".