Treatment of the microfilaraemia of asymptomatic brugian filariasis with single doses of ivermectin, diethylcarbamazine or albendazole, in various combinations

Several new chemotherapeutic tools are now available for the control of lym phatic filariasis. Combinations of single doses of antifilarial drugs are g enerally superior to single drugs. The efficacy and safety of albendazole i n combination with diethylcarbamazine (DEC) or ivermectin, for the treatmen t of Brugia malayi infection, were investigated, for the first time, in an open, hospital-based study. Fifty-one asymptomatic microfilaraemics (with 1 08-4034 microfilariae/ml; median = 531) of both sexes and aged 14-70 years were randomly allocated to receive single-dose treatments of ivermectin (20 0 mu g/kg) with diethylcarbamazine (DEC; 6 mg/kg), ivermectin (200 mu g/kg) with albendazole (400 mg), DEC (6 mg/kg) with albendazole (400 mg), or alb endazole (400 mg) alone. Albendazole alone had no effect on the microfilari al levels at the I-year follow-up but both groups given DEC had significant ly lower microfilaraemias (P < 0.015 and P < 0.02) than that given ivermect in with albendazole. Overall, 47%-64% of those given DEC but only 14% of th ose given ivermectin with albendazole appeared to be amicrofilaraemic 1 yea r post-treatment. The adverse reactions seen in the study were mild, transi ent and qualitatively similar to those seen earlier with ivermectin and DEC . The combination of DEC and albendazole, bath well tested drugs, offers a new option for countries such as India where there is no onchocerciasis or loiasis and where ivermectin may not be immediately available. The direct a nd indirect effects of albendazole on intestinal helminths would be additio nal benefits.