10.3205/ID000003
Specht, Sabine
Sabine
Specht
Debrah, Alexander Yaw
Alexander Yaw
Debrah
Klarmann, Ute
Ute
Klarmann
Mand, Sabine
Sabine
Mand
Hoerauf, Achim
Achim
Hoerauf
Pfarr, Kenneth
Kenneth
Pfarr
Chemotherapy of filariasis – established strategies and new developments
German Medical Science GMS Publishing House
2013
JournalArticle
610 Medical sciences; Medicine
2013-06-25
2013
en
urn:nbn:de:0183-id0000037
id000003
text/html
GMS Infectious Diseases; 1:Doc03; ISSN 2195-8831
Lymphatic filariasis (lympoedema and hydrocoele) and onchocerciasis (dermatitis and ocular inflammation) caused by the parasitic filarial nematodes Wuchereria bancrofti, Brugia spp. and Onchocerca volvulus lead to severe morbidity in developing tropical countries. Mass drug administration (MDA) programmes use ivermectin or diethylcarbamazine, often combined with albendazole, with the aim to eliminate filarial diseases. However, these drugs primarily only kill the first stage larvae, the microfilariae. Removal of the parasites’ mutualistic endosymbionts of the genus Wolbachia using anti-rickettsial drugs results in permanent worm sterility and death of the adult worms. Since it is currently not compatible with mass drug administration due to the comparatively long treatment time of 4–6 weeks, doxycycline has been recommended for physician-monitored treatment of individuals. For individuals suffering from filarial pathology, the use of doxycycline is the first drug to have the additional advantage of improving lymphoedema. However, new drugs and regimes need to be in the pipeline in order to tackle the upcoming or already existing problem areas, such as those with ivermectin resistance, areas coendemic for loiasis, or end-game scenarios. Here, we summarize current treatment options and review current research approaches for optimization of anti-helminthic therapy, including the exploration of optimized delivery strategies of ivermectin and albendazole, the discovery and development of new antibiotics for anti-wolbachial chemotherapy and macrofilaricidal antihelminthics.
GMS Infectious Diseases; 1:Doc03; ISSN 2195-8831