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

• 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 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

• 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.