A double-blind, placebo-controlled study of the efficacy of oral penicillin, diethylcarbamazine or local treatment of the affected limb in preventingacute adenolymphangitis in lymphoedema caused by brugian filariasis

Acute attacks of adenolymphangitis (ADL) contribute significantly to the mo rbidity seen in cases of filarial lymphoedema. Such cases are now being tre ated with multiple courses of the antifilarial drug diethylcarbamazine (DEC ), either alone or in combination with antibiotics or anti-inflammatory dru gs, based on anecdotal experience. In this, the first double-blind, placebo -controlled study, 150 patients with lymphoedema caused by brugian filarias is, each of whom recalled two or more ADL attacks in the previous year, wer e enrolled on a comprehensive foot-care programme. Each was also randomly a llocated to one of the following five daily regimens (30 patients/regimen) for 1 year: 800 mg oral penicillin; 1 mg DEC/kg; 800 mg oral penicillin plu s 1 mg DEC/kg; local antibiotics; or placebo. Each patient was followed up for another year. For each regimen group (including the placebo group), the number of ADL att acks in;the treatment year was significantly less than that in the year pri or to treatment (P < 0.001 for each). Although, in all but the placebo grou p, there was a slight increase in the number of episodes in the follow-up y ear compared with the treatment year, the increase was only significant in the two groups given penicillin. Of all the treatments tested therefore, fo ot care seems to play the most important role in the prevention of ADL atta cks. Additional benefit map accrue from local or systemic antibiotic use in those with high grades of oedema, but antifilarials have no place in the p revention of ADL attacks in an individual patient. These observations shoul d help in; the rational management and prevention of ADL attacks in filaria l lymphoedema, so that the progression of the disease may be halted and mor bidity reduced.