A controlled trial of ivermectin and diethylcarbamazine in lymphatic filariasis

Article Abstract:

Filaria are a family of nematode worms responsible for a number of parasitic diseases in man. The antifilarial drug ivermectin has been shown to effectively treat the filarial disease onchocerciasis, which is a major cause of blindness. However, the overwhelming majority of filarial infections are lymphatic; 90 million people worldwide are infected with Wuchereria bancrofti or Brugia malayi. Diethylcarbamazine is the most widely used treatment, but this drug requires daily administration for one or two weeks, which reduces its usefulness in some health programs. In a study involving 40 men in southern India, diethylcarbamazine was compared with the newer drug ivermectin, which requires only a single dose. Thirteen patients received low-dose ivermectin followed by 12 days of placebo, and 13 others received high-dose ivermectin followed by 12 days of placebo. Fourteen patients received diethylcarbamazine for 13 days. Eleven patients received placebo for five days and were then reassigned to another treatment group. After 12 days, there was a complete clearance of microfilariae from the blood of all 26 men who took ivermectin, indicating that the low dose was as effective as the high dose. Complete clearance of the circulating parasites occurred in 11 of the 14 men who took diethylcarbamazine. There were no differences of side effects among the groups. After six months, the patients who took ivermectin had roughly 19 percent of their pretreatment levels of microfilariae in the blood. Patients treated with diethylcarbamazine had 6 percent of their pretreatment levels of circulating parasites. The results indicate that ivermectin is more effective at the rapid clearance of microfilariae from the blood, but that diethylcarbamazine affords more long-lasting protection. The single-dose effectiveness of ivermectin is a distinct advantage, however, and continued testing should confirm if the drug will have as significant an impact on lymphatic filariasis around the world as it has had in the control of onchocerciasis in Africa and Latin America. (Consumer Summary produced by Reliance Medical Information, Inc.)

---

Bancroftian filariasis and ivermectin

Article Abstract:

Over a century ago, Bancroft's filariasis, the infection of the lymphatic system with the nematode worm Wuchereria bancrofti, became the first parasitic disease found to be transmitted by insect vectors. Filaria constitute a large family of parasites, producing a variety of syndromes and being carried by a variety of insects. W. bancrofti is carried by the mosquito, which releases third-stage larvae into the skin. Adult worms live in the lymphatic system, where they give birth to tiny worms called microfilariae, which circulate in the blood and may be sucked up by mosquitos for the next round of infection. One of the most dramatic symptoms of filarial infection is elephantiasis, which occurs when the adult organisms block the lymphatic drainage of limbs. The filaria are generally not fatal, but produce a variety of serious infirmities, including river blindness, or onchocerciasis. These disease have been treated for four decades with diethylcarbamazine. Although this drug does not cure the disease, the circulating microfilariae are cleared, which breaks the chain of parasitic transmission. Extensive treatment programs have aided vector-based efforts to control filarial disease, particularly onchocerciasis. The major drawback of diethylcarbamazine is that daily doses are needed for one or two weeks, a requirement which poses serious logistic problems for health programs. Now, in an article in the April 19, 1990 issue of The New England Journal of Medicine, the drug ivermectin has been reported to be effective in the reduction of microfilariae in the blood. The reduction of microfilariae by ivermectin was found to be more rapid and more complete than in patients treated with diethylcarbamazine, but the suppression did not last as long. The major advantage of ivermectin, however, is that it is effective in a single dose. This logistic advantage will certainly make ivermectin an important drug in the worldwide efforts to control filarial disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

---

Antiparasitic drugs

Article Abstract:

Innovative uses of established antiparasitic drugs and the availability of new drugs are reviewed. Parasites include helminths, such as roundworms, hookworms, and flukes. Helminths lay eggs but do not multiply in the host body like protozoa, the second major groups of parasites. Albendazole and ivermectin are potent new drugs that are slowly replacing standard treatment. Side effects include abdominal pain, nausea, vomiting, itching, and rash. The exact mechanism of the effective antihelmitic drug praziquantel is not known but may require an immune response in the host. Protozoan parasites include amebae, flagellates, ciliates, and sporozoa. Albendazole, fumagillin, trimethoprim-sulfamethoxazole, and paromomycin are effective drugs for a number of parasitic infections, including complications from AIDS.

Praziquantel, Benzimidazoles, Antiparasitic agents

Similar abstracts:

• Abstracts: A controlled trial of castration with and without nilutamide in metastatic prostatic carcinoma. Introduction to the Workshop on Combined Castration and Androgen Blockade Therapy in Prostate Cancer
• Abstracts: A randomized controlled trial of a reduced daily dose of zidovudine in patients with the acquired immunodeficiency syndrome
• Abstracts: High rate of infectivity and liver disease in blood donors with antibodies to hepatitis C virus. Evaluation of antibodies to hepatitis C virus in a study of transfusion-associated hepatitis
• Abstracts: Immunochemical characterization of circulating parathyroid hormone-related protein in patients with humoral hypercalcemia of cancer
• Abstracts: Parathyroid hormone-related peptide in sickness and in health. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.