Annals of Tropical Medicine & Parasitology
ISSN: 0003-4983 (Print) 1364-8594 (Online) Journal homepage: http://www.tandfonline.com/loi/ypgh19
Diethylcarbamazine treatment of bancroftian and malayan filariasis with emphasis on side effects P. C. Fan To cite this article: P. C. Fan (1992) Diethylcarbamazine treatment of bancroftian and malayan filariasis with emphasis on side effects, Annals of Tropical Medicine & Parasitology, 86:4, 399-405, DOI: 10.1080/00034983.1992.11812684 To link to this article: https://doi.org/10.1080/00034983.1992.11812684
Published online: 15 Nov 2016.
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Annals of Tropical Medicine and Parasitology, Vol. 86, No.4, 399-405 (1992)
Diethylcarbamazine treatment of bancroftian and malayan filariasis with emphasis on side effects BYP. C. FAN Department ofParasitology, National Yangming Medical College, Taipei, Taiwan, Republic of China
Received 18 December 1991, Revised 3 March 1992, Accepted 6 April1992
A total of 1015 filarial carriers were hospitalized and treated with DEC either in a long course with light doses (6, 7, 8, 9 or 10 mg kg- 1 b.w. divided into three doses daily for seven days) orin a short course with heavy doses (15 mg kg- 1 b.w. once daily for one, two or three days). The efficacy of the long course (85%) was much higher than that of the short course (59%); but the reaction rate following the heavy dose (87%) was higher than that following the light dose (72%). For Brugia malayi infections the overall efficacy was 92% and the reaction rate 82%, for mixed infections the respective rates were 85% and 77%, and for Wuchereria bancrofti infections 82% and 69%. The cure rates decreased from 93% in carriers with one to 10 microfilariae in 60 J.lm blood to 63% in those with over 100 Mff in 60 J.lm blood. Febrile reactions developed in 92% of carriers with mixed infections, in 91% of those with B. malayi, and in 84% of those with W. bancrofti. Overall, 63% of those treated were free of microfilariae on the last day of treatment, and 92% were free 48 months after treatment.
Diethylcarbamazine (DEC), first used clinically by Santiago-Stevenson et al. (1947) is the drug of choice for treating filariasis and for use in filariasis control programmes, but the occurrence of side effects is a serious problem. Symptoms such as fever, chills, dizziness, nausea and vomiting have been encountered after administration of DEC (Beaver et al., 1984). It is well known that side effects following DEC treatment are more serious among carriers of microfilariae (Mff) of Brugia malayi than among those with Wuchereria bancrofti, but there is little published information on this topic. The present study compares the efficacy of treatment with DEC and the seriousness of side effects in individuals with W. bancrofti, B. malayi and mixed infections with the two species. MATERIALS AND METHODS Following surveys carried out in Taiwan, Panghu, Kinmen and Mutsu a total of1015 Mff 0003-4983/92/040399 + 07 $08.00/0
carriers were found. These carriers were hospitalized and treated with DEC in one of two regimens. In a long-course schedule, each carrier was given 6, 7, 8, 9 or 10 mg kg - l body weight DEC in three divided doses daily for seven consecutive days. In a short-course schedule, each carrier was given 15 mg kg- 1 body weight (b.w.) DEC for one, two or three consecutive days. The body temperature, physical condition and side reactions of each of the patients were recorded daily before, during and after administration of DEC. Night blood (60 j..lm measured in a haemoglobin pipette) was taken from the ear lobe or finger of each patient, deposited in three parallel strips on the same microscope slide, dehaemoglobinized in distilled water and stained with Giemsa's stain. The number and species of Mff present were then determined microscopically. The Chi-square test, with or without Yates' correction, was used to compare the rates in the different infections. Results were considered statistically significant if P < 0·05. © 1992 Liverpool School of Tropical Medicine
400
FAN TABLE 1 Results oftreatment offilariasis with diethylcarbamazine Reactions*
Dosage (mgkg- 1 b.w.) daily
Daily dose divided into
No. of days treated
No. of cases treated
Microfilaria free
Positive
No. of cases examined
No.
%
No. of cases followed
38 78 68 49 447 680
38 78 68 49 447 680
29 65 56 41 384 575
76 83 82 84 86 85
38 78 68 49 447 680
25 54 49 36 328 492
66 69 72 73 73 72
85 101 149 335
42 72 137 251
IS
42 92 149
36 58 67 59
42 101 149 292
38 88 129 255
90 87 87 87
1015
931
724
78
972
747
77
No. of cases %
LONG-COURSE SCHEDULE OF TREATMENT
6 7 8 9 10 Sub-total
3 3 3 3 3
7 7 7 7 7
SHORT-COURSE SCHEDULE OF TREATMENT
15 IS
15 Sub-total
1 2 3
Total
*Fever, headache, vertigo, chill, nausea, vomiting, muscular and joint pain, lymphoglandular tenderness and swelling, testis and epididymis pain, nodule formation, tinnitus, convulsion and eruption.
RESULTS Efficacy of DEC in Treatment 'Efficacy' was measured as the percentage of carriers who showed no microfilaraemia after treatment. The efficacy of the long-course schedule administered to 680 Mff carriers was 85%, while that of the short-course schedule administered to 335 carriers was 59% (i=65·9, df= 1, P < 0·0 1). The detailed results are shown in Table 1. In the seven-day long-course schedule, the efficacy of the 10 mg kg- 1 dose was only slighdy better than that of other doses, and no statistically significant differences were found between the different rates ci = 3·0, df = 4, P
ISSN: 0003-4983 (Print) 1364-8594 (Online) Journal homepage: http://www.tandfonline.com/loi/ypgh19
Diethylcarbamazine treatment of bancroftian and malayan filariasis with emphasis on side effects P. C. Fan To cite this article: P. C. Fan (1992) Diethylcarbamazine treatment of bancroftian and malayan filariasis with emphasis on side effects, Annals of Tropical Medicine & Parasitology, 86:4, 399-405, DOI: 10.1080/00034983.1992.11812684 To link to this article: https://doi.org/10.1080/00034983.1992.11812684
Published online: 15 Nov 2016.
Submit your article to this journal
View related articles
Citing articles: 12 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ypgh19
Annals of Tropical Medicine and Parasitology, Vol. 86, No.4, 399-405 (1992)
Diethylcarbamazine treatment of bancroftian and malayan filariasis with emphasis on side effects BYP. C. FAN Department ofParasitology, National Yangming Medical College, Taipei, Taiwan, Republic of China
Received 18 December 1991, Revised 3 March 1992, Accepted 6 April1992
A total of 1015 filarial carriers were hospitalized and treated with DEC either in a long course with light doses (6, 7, 8, 9 or 10 mg kg- 1 b.w. divided into three doses daily for seven days) orin a short course with heavy doses (15 mg kg- 1 b.w. once daily for one, two or three days). The efficacy of the long course (85%) was much higher than that of the short course (59%); but the reaction rate following the heavy dose (87%) was higher than that following the light dose (72%). For Brugia malayi infections the overall efficacy was 92% and the reaction rate 82%, for mixed infections the respective rates were 85% and 77%, and for Wuchereria bancrofti infections 82% and 69%. The cure rates decreased from 93% in carriers with one to 10 microfilariae in 60 J.lm blood to 63% in those with over 100 Mff in 60 J.lm blood. Febrile reactions developed in 92% of carriers with mixed infections, in 91% of those with B. malayi, and in 84% of those with W. bancrofti. Overall, 63% of those treated were free of microfilariae on the last day of treatment, and 92% were free 48 months after treatment.
Diethylcarbamazine (DEC), first used clinically by Santiago-Stevenson et al. (1947) is the drug of choice for treating filariasis and for use in filariasis control programmes, but the occurrence of side effects is a serious problem. Symptoms such as fever, chills, dizziness, nausea and vomiting have been encountered after administration of DEC (Beaver et al., 1984). It is well known that side effects following DEC treatment are more serious among carriers of microfilariae (Mff) of Brugia malayi than among those with Wuchereria bancrofti, but there is little published information on this topic. The present study compares the efficacy of treatment with DEC and the seriousness of side effects in individuals with W. bancrofti, B. malayi and mixed infections with the two species. MATERIALS AND METHODS Following surveys carried out in Taiwan, Panghu, Kinmen and Mutsu a total of1015 Mff 0003-4983/92/040399 + 07 $08.00/0
carriers were found. These carriers were hospitalized and treated with DEC in one of two regimens. In a long-course schedule, each carrier was given 6, 7, 8, 9 or 10 mg kg - l body weight DEC in three divided doses daily for seven consecutive days. In a short-course schedule, each carrier was given 15 mg kg- 1 body weight (b.w.) DEC for one, two or three consecutive days. The body temperature, physical condition and side reactions of each of the patients were recorded daily before, during and after administration of DEC. Night blood (60 j..lm measured in a haemoglobin pipette) was taken from the ear lobe or finger of each patient, deposited in three parallel strips on the same microscope slide, dehaemoglobinized in distilled water and stained with Giemsa's stain. The number and species of Mff present were then determined microscopically. The Chi-square test, with or without Yates' correction, was used to compare the rates in the different infections. Results were considered statistically significant if P < 0·05. © 1992 Liverpool School of Tropical Medicine
400
FAN TABLE 1 Results oftreatment offilariasis with diethylcarbamazine Reactions*
Dosage (mgkg- 1 b.w.) daily
Daily dose divided into
No. of days treated
No. of cases treated
Microfilaria free
Positive
No. of cases examined
No.
%
No. of cases followed
38 78 68 49 447 680
38 78 68 49 447 680
29 65 56 41 384 575
76 83 82 84 86 85
38 78 68 49 447 680
25 54 49 36 328 492
66 69 72 73 73 72
85 101 149 335
42 72 137 251
IS
42 92 149
36 58 67 59
42 101 149 292
38 88 129 255
90 87 87 87
1015
931
724
78
972
747
77
No. of cases %
LONG-COURSE SCHEDULE OF TREATMENT
6 7 8 9 10 Sub-total
3 3 3 3 3
7 7 7 7 7
SHORT-COURSE SCHEDULE OF TREATMENT
15 IS
15 Sub-total
1 2 3
Total
*Fever, headache, vertigo, chill, nausea, vomiting, muscular and joint pain, lymphoglandular tenderness and swelling, testis and epididymis pain, nodule formation, tinnitus, convulsion and eruption.
RESULTS Efficacy of DEC in Treatment 'Efficacy' was measured as the percentage of carriers who showed no microfilaraemia after treatment. The efficacy of the long-course schedule administered to 680 Mff carriers was 85%, while that of the short-course schedule administered to 335 carriers was 59% (i=65·9, df= 1, P < 0·0 1). The detailed results are shown in Table 1. In the seven-day long-course schedule, the efficacy of the 10 mg kg- 1 dose was only slighdy better than that of other doses, and no statistically significant differences were found between the different rates ci = 3·0, df = 4, P
