title: Randomised controlled clinical trial of increased dose and frequency of albendazole and ivermectin on Wuchereria bancrofti microfilarial clearance in northern Malawi.
abstract: BACKGROUND
  In Africa, albendazole and ivermectin are currently used in combination for annual mass drug administration (MDA) for lymphatic filariasis (LF) elimination. Rapid and sustained clearance is desirable for public health impact and elimination of LF. Increasing the dose and/or frequency of albendazole and ivermectin treatment may be more effective in clearing microfilariae than standard MDA.
  
  
  METHODS
  We conducted a randomised controlled open label trial in northern Malawi comparing three modified treatment groups to standard dosage of ivermectin and albendazole in adults with confirmed circulating LF antigen and microfilaria. Participants were followed-up every 6 months for 2 years for repeat microfilarial counts and safety assessments.
  
  
  RESULTS
  A total of 1851 adults were screened and 70 with microfilarial counts >80 microfilariae/ml were randomised. All treatment groups achieved a significant reduction of microfilariae levels by 12- and 24-months of follow-up. Doubling the standard dose and administering it twice yearly showed a non-significant tendency towards faster and more complete clearance. There were no serious adverse reactions.
  
  
  CONCLUSIONS
  In this small study, all regimens effectively cleared microfilaria. Standard treatment may be adequate in settings like Malawi but not in all endemic settings and larger studies are required to demonstrate benefit of higher dosages. [ClinicalTrials.gov identifier: NCT01213576].
authors: Karonga Prevention Study, Chilumba, Karonga district, Malawi Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK ttafatatha@yahoo.com.
authors: Terence T
authors: TT
authors: Tafatatha
authors: Karonga Prevention Study, Chilumba, Karonga district, Malawi London School of Hygiene & Tropical Medicine, London, UK.
authors: Bagrey M
authors: BM
authors: Ngwira
authors: Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
authors: Miriam
authors: M
authors: Taegtmeyer
authors: Karonga Prevention Study, Chilumba, Karonga district, Malawi.
authors: Amos J
authors: AJ
authors: Phiri
authors: Karonga Prevention Study, Chilumba, Karonga district, Malawi London School of Hygiene & Tropical Medicine, London, UK.
authors: Trevor P
authors: TP
authors: Wilson
authors: Karonga Prevention Study, Chilumba, Karonga district, Malawi.
authors: Louis G
authors: LG
authors: Banda
authors: Karonga Prevention Study, Chilumba, Karonga district, Malawi.
authors: Wilson N
authors: WN
authors: Piston
authors: Karonga Prevention Study, Chilumba, Karonga district, Malawi London School of Hygiene & Tropical Medicine, London, UK.
authors: Olivier
authors: O
authors: Koole
authors: Tropical Projects, Hitchin, UK.
authors: John
authors: J
authors: Horton
authors: Karonga Prevention Study, Chilumba, Karonga district, Malawi Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
authors: Neil
authors: N
authors: French
mesh_terms: D000328:Adult; D015766:Albendazole / Q000008:administration & dosage*; D000818:Animals; D004359:Drug Therapy, Combination; D019353:Endemic Diseases; D005260:Female; D005368:Filariasis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D007559:Ivermectin / Q000008:administration & dosage*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008842:Microfilariae / Q000187:drug effects*; D008875:Middle Aged; D018512:Parasitemia; D014958:Wuchereria bancrofti / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D007559:Ivermectin; D015766:Albendazole
keywords: Albendazole; Clinical trial; Ivermectin; Lymphatic filariasis; Malawi; Microfilaria