More than half of filariasis cases in South-East Asia are caused by Brugia malayi

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[JAKARTA] A commonly-used antibiotic is most suitable to eliminate the most common form of lymphatic filariasis in South-East Asia, say researchers.

Lymphatic filariasis — a cause of elephantiasis — is caused by the nematode worms Wuchereria bancrofti and Brugia malayi, which colonise the lymphatic system, block ducts and cause debilitating swelling.

The standard treatment is a combination of the drugs diethylcarbamazine and albendazole, but these cause side effects such as fever, headache, dizziness, and enlarged lymph nodes.

The antibiotic doxycycline is known to be effective against filariasis caused by Wuchereria bancrofti, but more than half of cases in South-East Asia are caused by Brugia malayi.

The researchers treated 161 adult participants with Brugia malayi filariasis in Indonesia with either doxycycline, diethylcarbamazine and albendazole, both treatments or placebo versions for six weeks.

They found that 77 per cent of patients receiving doxycycline were negative for Brugia malayi after one year, as opposed to 27 per cent that had received diethylcarbamazine and albendazole. Doxycycline also caused the lowest side effects.

"Since the treatment is a full six-week course of 100 mg of doxycycline per day, we are not suggesting the Government of Indonesia use doxycycline as a mass treatment," Taniawati Supali, lead researcher from the Department of Parasitology, University of Indonesia told SciDev.Net.

Supali says that the biggest obstacle to eliminating filariasis in Indonesia with doxycycline is that many sufferers live far from medical facilities, and might not be disciplined in collecting and taking their pills every day.

"I am concerned that, if the sufferer failed to take doxycycline at the right doses, the worms will acquire more resistance than previously," she says.

Sekartuti, a team leader at the National Filariasis Elimination Program at the Ministry of Health, said, "Indonesia is now using a community-based strategy, giving single oral treatment diethylcarbamazine annually for a term of five years."

But she agrees that doxycycline is most suitable for individual treatment in those with a high level of discipline and better access to healthcare.

Sekartuti estimates the number of people living with filariasis in Indonesia is around ten million, and that 150 million Indonesians live in areas where filariasis is endemic.

The study is published in the May issue of Clinical Infectious Diseases.

Link to abstract in Clinical Infectious Diseases