Abstract | BACKGROUND: Wolbachia endosymbionts of filarial nematodes are vital for larval development and adult-worm fertility and viability. This essential dependency on the bacterium for survival of the parasites has provided a new approach to treat filariasis with antibiotics. We used this strategy to investigate the effects of doxycycline treatment on the major cause of lymphatic filariasis, Wuchereria bancrofti. METHODS: We undertook a double-blind, randomised, placebo-controlled field trial of doxycycline (200 mg per day) for 8 weeks in 72 individuals infected with W bancrofti from Kimang'a village, Pangani, Tanzania. Participants were randomly assigned by block randomisation to receive capsules of doxycycline (n=34) or placebo (n=38). We assessed treatment efficacy by monitoring microfilaraemia, antigenaemia, and ultrasound detection of adult worms. Follow-up assessments were done at 5, 8, 11, and 14 months after the start of treatment. Analysis was per protocol. FINDINGS: One person from the doxycycline group died from HIV infection. Five ( doxycycline) and 11 (placebo) individuals were absent at the time of ultrasound analysis. Doxycycline treatment almost completely eliminated microfilaraemia at 8-14 months' follow-up (for all timepoints p<0.001). Ultrasonography detected adult worms in only six (22%) of 27 individuals treated with doxycycline compared with 24 (88%) of 27 with placebo at 14 months after the start of treatment (p<0.0001). At the same timepoint, filarial antigenaemia in the doxycycline group fell to about half of that before treatment (p=0.015). Adverse events were few and mild. INTERPRETATION: An 8-week course of doxycycline is a safe and well-tolerated treatment for lymphatic filariasis with significant activity against adult worms and microfilaraemia.
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Authors | Mark J Taylor, Williams H Makunde, Helen F McGarry, Joseph D Turner, Sabine Mand, Achim Hoerauf |
Journal | Lancet (London, England)
(Lancet)
2005 Jun 18-24
Vol. 365
Issue 9477
Pg. 2116-21
ISSN: 1474-547X [Electronic] England |
PMID | 15964448
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anti-Bacterial Agents
- Doxycycline
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Topics |
- Adolescent
- Adult
- Aged
- Animals
- Anti-Bacterial Agents
(therapeutic use)
- Double-Blind Method
- Doxycycline
(therapeutic use)
- Elephantiasis, Filarial
(drug therapy, parasitology)
- Humans
- Male
- Middle Aged
- Wolbachia
(drug effects)
- Wuchereria bancrofti
(drug effects, microbiology)
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