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Approach to treatment of a patient with lymphatic filariasis, onchocerciasis,

and/or loiasis

Lymphatic Treatment of Alternative

Onchocerciasis Loiasis Comments
filariasis choice treatments

+ - - DEC (6 mg/kg for 1. IVM (200  

12 days)* mcg/kg)
+ ALB
(400 mg)
2. IVM (200
mcg/kg)
+ DEC (6
mg/kg)
3. ALB (200
mg twice
daily for
21 days)
4. DOXY
(200 mg
daily for
six
weeks)

- + - IVM (150 mcg/kg IVM (150 DEC can cause severe

every 6 to 12 mcg/kg) + post-treatment
months) DOXY (200 mg reactions and
daily for six exacerbate ocular
weeks) disease

- - + Low microfilariae: ALB (200 DEC and IVM can

DEC (8 mg/kg/day mg twice provoke serious side
for 21 days) daily for 21 effects in patients with
days) ¶ high microfilariae
High microfilariae:
counts
Apheresis or ALB
(200 mg twice
daily for 21 days)
to
lower microfilariae
count prior to DEC
 + + - IVM (150 mcg/kg) 1. IVM (200 Pretreatment with IVM
followed by DEC (6 mcg/kg) to clear
mg/kg for 12 + ALB Onchocerca microfilariae
days) (400 mg) is necessary prior to
2. IVM + administration of DEC
ALB (200 for LF
mg twice
daily for
21 days)
3. IVM +
DOXY
(200 mg
daily for
six
weeks)

+ - + Same as Loa alone Same as Loa Same as Loa alone

alone

- + + Low microfilariae: IVM (150 Due to the slow effect

IVM (150 mcg/kg) mcg/kg) + ALB of ALB on Loa
followed by DEC (8 (200 mg twice microfilariae, ALB
mg/kg for 21 daily for 21 should only be used as
days) days) an alternative to
apheresis to lower
High microfilariae:
Loa microfilariae if there
Apheresis to
is no evidence of
lower microfilariae
onchocercal eye
prior to IVM
involvement
followed by DEC
(as for low
microfilariae)

+ + + Same as Same as Same as Onchocerca +

Onchocerca + Loa Onchocerca + Loa
Loa

DEC: diethylcarbamazine; IVM: ivermectin; ALB: albendazole; DOXY: doxycycline.

* A longer course (14 to 21 days) is recommended for tropical pulmonary eosinophilia.

¶ This regimen has only been demonstrated to be effective in DEC-refractory disease.

Graphic 86736 Version 2.0