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Doxycycline treatment of Brugia malayi-infected persons reduces microfilaremia and adverse reactions after diethylcarbamazine and albendazole treatment

Supali, T., Djuardi, Y., Pfarr, K. M., Wibowo, H., Taylor, Mark, Hoerauf, A., Houwing-Duistermaat, J. J., Yazdanbakhsh, M. and Sartono, E. (2008) 'Doxycycline treatment of Brugia malayi-infected persons reduces microfilaremia and adverse reactions after diethylcarbamazine and albendazole treatment'. Clinical Infectious Diseases, Vol 46, Issue 9, pp. 1385-1393.

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Abstract

Background. The efficacy of doxycycline for treating the causal agent of human lymphatic filariasis, Brugia malayi, is unknown. Standard treatment with diethylcarbamazine- albendazole is associated with adverse reactions. We assessed whether doxycycline alone or in combination with diethylcarbamazine- albendazole would lead to sustained amicrofilaremia and reduced incidence of adverse reactions.
Methods. A double- blind, randomized, placebo- controlled 6- week field trial of doxycycline treatment ( 100 mg/ day) of 161 persons infected with B. malayi was conducted. Four months after receiving doxycycline ( np) or placebo (), participants received diethylcarbamazine ( 6 mg/ kg) plus albendazole ( 400 mg) or a 119 np=42 matching placebo. Adverse reactions were assessed 48 and 60 h after administration of diethylcarbamazine- albendazole. Treatment efficacy was evaluated at 2, 4, and 12 months after the initial doxycycline treatment.
Results. Four months after beginning doxycycline treatment, Wolbachia loads were reduced by 98%. Doxycycline treatment reduced the prevalence of microfilaremia at 2, 4, and 12 months of follow- up ( for all P <.001 time points). At the 1- year follow- up, prevalence was reduced by 77% and 87.5% in patients receiving doxycycline alone or doxycycline plus diethylcarbamazine- albendazole, respectively. In contrast, the reduction of microfilaremia in the group receiving placebo doxycycline plus diethylcarbamazine- albendazole was merely 26.7%. Adverse reactions were lowest in the group receiving doxycycline plus placebo diethylcarbamazine- albendazole and highest in the group receiving placebo doxycycline plus diethylcarbamazine- albendazole. The proportion of persons with high fever and severe adverse reactions was significantly reduced in the group treated with doxycycline plus diethylcarbamazine- albendazole.
Conclusions. A 6- week course of doxycycline, either alone or in combination with diethylcarbamazine- albendazole, leads to a decrease in microfilaremia and reduces adverse reactions to antifilarial treatment in B. malayi infected persons.

Item Type: Article
Uncontrolled Keywords: lymphatic filariasis wuchereria-bancrofti macrofilaricidal activity wolbachia endosymbionts double-blind worm death ivermectin nematodes depletion efficacy
Subjects: WC Communicable Diseases > Tropical and Parasitic Diseases > WC 880 Filariasis and related conditions (General)
QX Parasitology > Helminths. Annelida > QX 301 Filarioidea
QV Pharmacology > QV 38 Drug action.
Digital Object Identifer (DOI): https://doi.org/10.1086/586753
Depositing User: Mary Creegan
Date Deposited: 19 Jul 2010 14:02
Last Modified: 15 Jun 2018 14:46
URI: http://archive.lstmed.ac.uk/id/eprint/928

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