[Diethylcarbamazine in the treatment of Bancroft's filariasis]

Adverse reactions following mass drug administration with diethylcarbamazine in lymphatic filariasis endemic areas in the Northeast of Brazil

INTRODUCTION

The Global Programme to Eliminate Lymphatic Filariasis was launched with the goal of eliminating this disease via the annual mass drug administration (MDA) of a single dose of antifilarial drugs. Adverse drug reactions following MDA are a major factor of poor treatment adherence in several countries. This study assessed the occurrence of adverse drug reactions (ADRs) following the first round of mass treatment in two communities treated with different dosages of diethylcarbamazine (DEC) in the City of Recife, Brazil.

METHODS

Population-based cross-sectional surveys were conducted in a random sample of the population living in both communities (Areas I and II). The dose of DEC recommended by the WHO (6mg/kg) was calculated based on the individual's weight-for-age. In Area II, weight differences between the genders were also considered when determining dosage. Data were obtained through interviews conducted in the first 12 to 48h and on the 5th day after MDA during household visits.

RESULTS

A total of 487 and 365 individuals were interviewed in Areas I and II, respectively. The prevalence of ADRs in Area I (23.6; 95%CI: 19.1-29.5) was higher than in Area II (16.2; 95%CI:11.9-21.5)(p=0.0078). The prevalence of ADRs among females was higher than in males in Area I (p=0.0021). In Area II, no significant difference between the genders was observed (p=0.1840). Age was not associated with ADRs in either area.

CONCLUSIONS

Adjusting MDA dosage schedules according to weight-for-age and sex may be may contribute to reduce the occurrence of adverse drug reactions in the population.

Situação da filariose bancroftiana na Região Metropolitana do Recife: estudo em uma área endêmica no Município de Jaboatão dos Guararapes, Pernambuco, Brasil

Este artigo apresenta os resultados do inquérito epidemiológico que estudou a ocorrência e a distribuição da filariose bancroftiana no Distrito de Cavaleiro, Município de Jaboatão dos Guararapes, Pernambuco. O desenho de estudo empregado foi o seccional. Foram analisados 9.520 indivíduos da população residente nos 12 bairros que compõem o distrito. Deste total, detectou-se 213 microfilarêmicos (2,2%). Cerca de 91,7% dos bairros pesquisados apresentaram casos de infecção filarial, com prevalências variando de 0% a 5,15%. A população masculina foi a mais acometida pela infecção, com 64,3% dos casos (p < 0,05). Verificou-se, também, a existência de positividade em todas as faixas etárias examinadas. Esses resultados indicam que a filariose bancroftiana permanece como um problema de saúde pública na região, necessitando de medidas de controle e atenção dos administradores e planejadores de saúde.

[Recommendations for the treatment of bancroftian filariasis in symptomless and diseased patients]

The goals of treatment for lymphatic filariasis are: to prevent, reverse, or halt progression of disease; and to interrupt transmission of the parasite. Selecting the appropriate therapy for the patient with lymphatic filariasis requires knowledge of the various clinical features of filarial disease and their pathogenesis. In the past, treatment of lymphatic filariasis has focused primarily on antiparasitic chemotherapy; however, for many of the acute and chronic manifestations of lymphatic filariasis, it is now clear that supportive or other forms of clinical care are even more important than antiparasitic medication in order to prevent worsening of the disease. Regardless of the clinical manifestations of filarial disease in a particular patient, the following three components of treatment should, in general, be considered: supportive or disease specific clinical care (including hygiene and diet), patient education and counseling and finally, antiparasitic chemotherapy with diethylcarbamazine (DEC) and/or the combination of DEC with ivermectin. The authors also describe the proportional efficacy of diethylcarbamazine and ivermectin, alone or in combination, for use in mass treatment aiming at transmission interruption and the use of hygiene as a public health approach for lymphedema prevention.