RANDOMIZED PLACEBO-CONTROLLED COMPARISON OF IVERMECTIN AND ALBENDAZOLE ALONE AND IN COMBINATION FOR WUCHERERIA-BANCROFTI MICROFILAREMIA IN HAITIAN CHILDREN
Dg. Addiss et al., RANDOMIZED PLACEBO-CONTROLLED COMPARISON OF IVERMECTIN AND ALBENDAZOLE ALONE AND IN COMBINATION FOR WUCHERERIA-BANCROFTI MICROFILAREMIA IN HAITIAN CHILDREN, Lancet, 350(9076), 1997, pp. 480-484
Background Lymphatic filariasis and intestinal helminth infections are
important disorders in tropical areas. Periodic treatment with albend
azole is now used in many school-based intestinal helminth-control pro
grammes. However, few such programmes exist for lymphatic filariasis,
despite evidence that single-dose treatment with ivermectin can greatl
y reduce the concentration of Wuchereria bancrofti microfilariae in th
e blood for months to years. We aimed to assess the potential for scho
ol-based control of lymphatic filariasis by investigating the efficacy
and tolerability of combined ivermectin and albendazole in Haitian sc
hoolchiidren. Methods in January, 1996, we collected 832 20 mu L capil
lary blood samples for inclusion in a randomised controlled study from
children aged 5-11 years, and examined them by microscopy for W bancr
ofti microfilariae. Infected children were randomly assigned treatment
with placebo (n=29), a single 200-400 mu g/kg dose of ivermectin (mea
n, 273 mu g/kg, n=28), 400 mg albendazole (n=29), or a combination of
200-400 mu g/kg ivermectin and 400 mg albendazole (n=24). Children wit
h high concentrations of microfilariae in the blood were admitted to h
ospital and adverse reactions were monitored for 3-5 days, otherwise c
hildren were examined at school or during a visit to their home. 4 mon
ths after treatment, we examined blood samples again for microfilariae
. Findings 113 microfilaraemic children were enrolled (mean age 7.8 ye
ars). 4 months after treatment, the proportion of children who remaine
d positive for microfilariae was significantly lower in the ivermectin
plus albendazole group (four [17%]), but there were no significant ch
anges in the other three groups (20 [69%] placebo, 22 [76%] albendazol
e alone, 17 [61%] ivermectin alone remained positive; p=0004). Geometr
ic mean microfilarial concentration decreased from 9.3 to 5.3 per 20 m
u L blood among children who received placebo; from 15.5 to 1.5 per 20
mu L blood among those who received ivermectin only (p=0.032); from 1
4.1 to 5.1 per 20 mu L blood among those who received albendazole alon
e; and from 13.7 to 0.3 per 20 mu L blood among those who received bot
h ivermectin and albendazole (p=0.0001). Systemic adverse reactions di
d not differ significantly between the four groups. Interpretation For
children with W bancrofti microfilaraemia, combined treatment with iv
ermectin and albendazole was more effective than treatment with iverme
ctin only, with no measurable increase in severity of adverse reaction
s.