Lymphatic Filariasis Treatment Guidelines

Critical Pre-Treatment Screening

The World Health Organization recommends excluding Loa loa infection in patients who have traveled to endemic regions before treating with ivermectin or DEC, to prevent life-threatening complications 1, 2
The Centers for Disease Control and Prevention advises excluding onchocerciasis before using DEC, as co-infection is contraindicated 1, 2
Failure to screen for co-infections can result in severe neurological adverse events, including encephalitis and death, particularly in patients with high microfilarial loads 3

The American College of Obstetricians and Gynecologists recommends avoiding DEC in pregnancy and seeking expert consultation 2
The World Health Organization suggests that ivermectin can be used in the second and third trimesters of pregnancy, as it has no observed teratogenicity in limited human data 2
The National Institute of Child Health and Human Development states that ivermectin is excreted in very low levels in breast milk and is likely compatible with breastfeeding 2, 4
The American Academy of Pediatrics recommends that children aged 12-24 months should be discussed with an expert before treatment, while children over 24 months can receive standard dosing 1

The National Institutes of Health recommends that ivermectin should be taken with food, as bioavailability increases 2.5 times with high-fat meals 2, 4
The Centers for Disease Control and Prevention advises that albendazole should be taken with or after food 2
The Food and Drug Administration warns that azithromycin can significantly increase serum ivermectin concentrations, and caution should be used with co-administration 2

The Infectious Diseases Society of America recommends that when using DEC with microfilaraemia present, prednisolone is usually given alongside to reduce inflammatory reactions 2
The American Society of Clinical Oncology suggests that FBC/LFTs should be performed every two weeks for 3 months, then monthly if within normal range (for prolonged courses) 2
The National Institute on Alcohol Abuse and Alcoholism warns patients that alcohol may worsen side effects 2

The World Health Organization recommends obtaining skin snips for microscopy to screen for onchocerciasis, and performing slit lamp examination, with a test dose of DEC 50 mg if unavailable, to prevent life-threatening complications in patients with onchocerciasis co-infection 5, 6, 7
The Centers for Disease Control and Prevention suggests obtaining daytime blood microscopy using 20 ml citrated blood to screen for Loa loa co-infection, with determination of microfilarial count if positive, to prevent fatal encephalopathy in patients with high Loa loa microfilarial loads 5

The American Society of Tropical Medicine and Hygiene recommends diethylcarbamazine (DEC) 6 mg/kg in 3 divided doses for 14 days, plus doxycycline 200 mg daily for 6 weeks, for the treatment of lymphatic filariasis in a 70 kg woman, after excluding onchocerciasis and loiasis co-infection 5
The World Health Organization suggests an alternative regimen of ivermectin 200 μg/kg as a single dose, plus albendazole 400 mg as a single dose, in onchocerciasis co-endemic areas where DEC is contraindicated 5, 6, 7

The Infectious Diseases Society of America recommends monitoring for adverse reactions, such as fever, lymphadenitis, and lymphangitis, during treatment with DEC and doxycycline 5