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Diethylcarbamazine (DEC) (Hetrazan, Benocide) rapidly kills microfilaria and can

kill some, but not all adults of both Wuchereria and Brugia. DEC exerts no direct
lethal effect on microfilarae but apparently modifies them so that they are
eliminated by host's immune defense mechanism.[4] The standard dose is 6
mg/kg, which is to be given in three divided doses after food over a period of 10-
14 days, which reduces microfilaremia levels by approximately 80-90% in several
days. Initially lower dose (1-3 mg/kg) once a day should be started in order to
decrease side effects of the drug in cases of heavy parasitic load. Drug reactions
due to dying worm may commence after the start of the medical treatment.
These reactions may be local or systemic. Systemic reactions include fever,
headache, myalgia, vomiting, weakness and asthma; usually result from rapid
destruction of microfilariae and perhaps adult worms, specially in heavily
infected individuals. Local reactions include lymphadenitis, abscess formation
and transient lymhadema. These symptoms develop within 2 days, often within
12 h, after initiation of the treatment and persist for 3-4 days. The drug is not
recommended during pregnancy though no teratogenic effect so far has been
reported. Side effects of DEC therapy may be reduced with spacing in between
the two doses like single dose of 6 mg/g once weekly, twice monthly or once
monthly. DEC treatment of micofillraemic patients and with acute symptoms
eliminates the episodes of acute lymphatic inflammation that may prevent the
development of obstructive lesions hence reducing the incidence of chyluria. The
drug is rapidly excreted and nontoxic; can be repeated at 1 month following
completion of the first course. Multiple courses of treatment may be required
which may be repeated at 6 months interval. Peripheral eosinophilia often
accompanies the infection with this parasite that should resolve with the
response of the treatment. If peripheral eosinophilia and/or clinical symptoms
persist after treatment, peripheral blood should be re-examined for
microfilaremia/or circulating antigen.[5],[6]

The two other drugs which have used been in the treatment of filarial infestation
are ivermecten and albendazole. Ivermectin kills microfilarae only and can be
given as single dose of 400 mg/kg. All though ivermectin leads to rapid clearance
of microfilarae, sustained reductions at six moths or longer after treatment are
equivalent or better with single 6 mg/kg dose of DEC. This is consistent with DEC
having a greater effect on adult worms. Ivermectin can also be used with DEC as
single dose that gives more rapid clearance of microfilarae and recurrence is
delayed. Side effects of ivermectin are similar to that of DEC with additional
neurotoxicity. Albendazole 400 mg as single dose in combination with ivermectin
is more effective in clearing microfilarae than ivermectin alone