title: 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.affiliation: Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. taniawati@yahoo.com
authors.forename: Taniawati
authors.initials: T
authors.lastname: Supali
authors.forename: Yenny
authors.initials: Y
authors.lastname: Djuardi
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Pfarr
authors.forename: Heri
authors.initials: H
authors.lastname: Wibowo
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Taylor
authors.forename: Achim
authors.initials: A
authors.lastname: Hoerauf
authors.forename: Jeanine J
authors.initials: JJ
authors.lastname: Houwing-Duistermaat
authors.forename: M
authors.initials: M
authors.lastname: Yazdanbakhsh
authors.forename: Erliyani
authors.initials: E
authors.lastname: Sartono
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015766:Albendazole / Q000009:adverse effects / Q000627:therapeutic use*; D000818:Animals; D017178:Brugia malayi / Q000187:drug effects*; D002648:Child; D004049:Diethylcarbamazine / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004318:Doxycycline / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004605:Elephantiasis, Filarial / Q000188:drug therapy*; D005260:Female; D005369:Filaricides / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D005369:Filaricides; D015766:Albendazole; D004318:Doxycycline; D004049:Diethylcarbamazine