From the Guidelines
Treatment for filariasis when blood tests positive should be initiated promptly with diethylcarbamazine (DEC) 6 mg/kg in 3 divided doses for 14 days, plus doxycycline 200 mg daily for 6 weeks, after excluding onchocerciasis and loiasis if the patient has travelled to co-endemic areas, as recommended by the most recent guidelines 1. When treating filariasis, it is crucial to consider the potential for co-infection with other diseases such as onchocerciasis and loiasis, which can affect the choice of treatment and the risk of adverse reactions.
- The primary concern is to prevent progression to chronic lymphatic damage, which becomes irreversible.
- Patients should be monitored for adverse reactions, particularly fever, headache, and muscle pain, which can occur as the parasites die.
- These symptoms can be managed with antipyretics and anti-inflammatory medications.
- Elevation of affected limbs, good hygiene, and compression garments are important supportive measures for those with lymphedema.
- Even after treatment, patients should have follow-up blood tests to confirm clearance of microfilariae from the bloodstream, as suggested by recent studies 1. It is essential to seek specialist input before treating patients for filarial infection, especially if they have travelled to co-endemic areas, to ensure the best possible outcome and minimize the risk of complications.
- The treatment regimen may need to be adjusted based on the patient's specific condition and medical history.
- In cases of onchocerciasis or loiasis co-infection, expert advice should be sought to determine the best course of treatment.
- Recent guidelines emphasize the importance of excluding onchocerciasis and loiasis before initiating treatment with DEC, to avoid severe reactions such as blindness, hypotension, pruritus, and erythema 1.
From the FDA Drug Label
INDICATIONS AND USAGE STROMECTOL is indicated for the treatment of the following infections: Strongyloidiasis of the intestinal tract... Onchocerciasis. The FDA drug label does not answer the question.
From the Research
Filariasis Treatment
If blood tests show positive results for filariasis, treatment typically involves antifilarial drugs. The following are some key points to consider:
- A single-dose triple-drug therapy of diethylcarbamazine (DEC), ivermectin (IVM), and albendazole (ALB) has been shown to be effective in reducing microfilaria levels in the blood 2.
- This triple-drug therapy has been found to be more effective than a two-drug regimen of DEC and ALB in clearing microfilaria from the blood 2.
- The use of albendazole alone or in combination with microfilaricidal drugs has been evaluated in several studies, with mixed results 3.
- A study in Côte d'Ivoire found that a single dose of IDA (ivermectin, diethylcarbamazine, and albendazole) was superior to standard treatment with ivermectin and albendazole in reducing microfilaria levels in the blood at 6 and 12 months 4.
- Diagnosis of filariasis typically involves identification of microfilariae in blood or skin samples, antigen detection, radiographic imaging, or polymerase chain reaction 5.
Treatment Options
Some treatment options for filariasis include:
- Diethylcarbamazine (DEC)
- Ivermectin (IVM)
- Albendazole (ALB)
- Combination therapy with DEC, IVM, and ALB
- Mass drug administration programs, which have been shown to be effective in reducing the incidence of filariasis 5.
Recent Advances
Recent advances in filariasis research include: