The progression of lymphoedema to
elephantiasis associated with increased incidence of episodic adeno-
lymphangitis (
ADL) is of great concern, as it causes
physical suffering, permanent disability and economic loss to
lymphatic filariasis patients. This randomized clinical trial aimed to assess the efficacy in terms of reduction of oedema and
ADL frequency of three treatment regimens among lymphoedema patients from Orissa, India. The regimens were: (I) oral
penicillin--one
tablet of 800 000 U
penicillin G potassium twice daily for 12 days--repeated every 3 months for 1 year; (II) diethylcarbamazine--6 mg/kg bodyweight for 12 days-repeated every 3 months for 1 year; and (III) topical
antiseptic, i.e.
betadine ointment. Foot care was part of all regimens. All three
drug regimens are efficacious in reducing oedema and frequency of
ADL episodes. Although the efficacy was slightly higher in regimen I, the difference was not significant. About half of all patients had reduced oedema after the 90 days of treatment, with oedema reduction of 75-100% in 20%. A major proportion of the remaining patients had oedema reduced by less than 25%. The proportion of people whose oedema reduced was slightly but not significantly lower in regimen II. anova revealed that lymphoedema reduction varied according to grade; being greatest at grade 1 lymphoedema, followed by grade 2. All three regimens significantly reduced
ADL frequency after 1 year of treatment. This may be because of foot care as well as use of
antibiotics. The estimated costs of treatment per patient for a period of 3 months are US$2.4, 1.5 and 4.0 respectively for regimen I, II and III. Thus affordable treatments with simple
antibiotics and foot care can give substantial relief to the patients and reverse early lymphoedema.