Doxycycline treatment of Brugia malayi-infected persons reduces microfilaremia and adverse reactions after diethylcarbamazine and albendazole treatment.

Abstract

BACKGROUND:

The efficacy of doxycycline for treating the causal agent of human lymphatic filariasis, Brugia malayi, is unknown. Standard treatment with diethylcarbamazine-albendazole is associated with adverse reactions. We assessed whether doxycycline alone or in combination with diethylcarbamazine-albendazole would lead to sustained amicrofilaremia and reduced incidence of adverse reactions.

METHODS:

A double-blind, randomized, placebo-controlled 6-week field trial of doxycycline treatment (100 mg/day) of 161 persons infected with B. malayi was conducted. Four months after receiving doxycycline (n=119) or placebo (n=42), participants received diethylcarbamazine (6 mg/kg) plus albendazole (400 mg) or a matching placebo. Adverse reactions were assessed 48 and 60 h after administration of diethylcarbamazine-albendazole. Treatment efficacy was evaluated at 2, 4, and 12 months after the initial doxycycline treatment.

RESULTS:

Four months after beginning doxycycline treatment, Wolbachia loads were reduced by 98%. Doxycycline treatment reduced the prevalence of microfilaremia at 2, 4, and 12 months of follow-up (P<.001 for all time points). At the 1-year follow-up, prevalence was reduced by 77% and 87.5% in patients receiving doxycycline alone or doxycycline plus diethylcarbamazine-albendazole, respectively. In contrast, the reduction of microfilaremia in the group receiving placebo doxycycline plus diethylcarbamazine-albendazole was merely 26.7%. Adverse reactions were lowest in the group receiving doxycycline plus placebo diethylcarbamazine-albendazole and highest in the group receiving placebo doxycycline plus diethylcarbamazine-albendazole. The proportion of persons with high fever and severe adverse reactions was significantly reduced in the group treated with doxycycline plus diethylcarbamazine-albendazole.

CONCLUSIONS:

A 6-week course of doxycycline, either alone or in combination with diethylcarbamazine-albendazole, leads to a decrease in microfilaremia and reduces adverse reactions to antifilarial treatment in B. malayi-infected persons.

• Authors: Taniawati Supali, Yenny Djuardi, Kenneth M Pfarr, Heri Wibowo, Mark J Taylor, Achim Hoerauf, Jeanine J Houwing-Duistermaat, M Yazdanbakhsh, Erliyani Sartono
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 46 Issue 9 Pg. 1385-93 (May 01 2008) ISSN: 1537-6591 [Electronic] United States
• PMID: 18419441 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Filaricides
• Albendazole
• Doxycycline
• Diethylcarbamazine

Topics

• Adolescent
• Adult
• Aged
• Albendazole (adverse effects, therapeutic use)
• Animals
• Brugia malayi (drug effects)
• Child
• Diethylcarbamazine (adverse effects, therapeutic use)
• Double-Blind Method
• Doxycycline (therapeutic use)
• Drug Therapy, Combination
• Elephantiasis, Filarial (drug therapy)
• Female
• Filaricides (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged
• Treatment Outcome