Loiasis (African Eye Worm) Medication

Updated: Jun 03, 2020
  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications. Treatment involves microfilaricidal and/or macrofilaricidal agents, as follows: [33]

  • If the microfilarial density is below 2000 mf/mL, DEC should be administered straightaway.
  • If the microfilarial density is between 2000 and 8000 mf/mL, ivermectin should be used to reduce microfilaremia to less than 2000 mf/mL for DEC treatment.
  • If the microfilarial density is between 8000 and 30,000 mf/mL, ivermectin or albendazole should be used to reduce microfilaremia to less than 2000 mf/mL for DEC treatment.
  • If the microfilarial density is above 30,000 mf/mL, albendazole or apheresis should be used to reduce microfilaremia to less than 2000 mf/mL for DEC treatment.

Individuals treated with ivermectin do not need to be retested for microfilarial density before the next treatment, as over 99.9% remain below the level associated with severe complications. [45]

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Anthelmintics

Diethylcarbamazine

Not commercially available in the United States (available only through the CDC). Has both microfilaricidal and macrofilaricidal effects. For use in cases of symptomatic loiasis parasitemia of less than 8000 L loa microfilariae/mL. Serves as an inhibitor of arachidonic acid metabolism in microfilaria.

CDC guidelines (adult and pediatric dose): 8-10 mg/kg/day orally in 3 divided doses daily for 21 days

Alternatively: 3 or 6 mg/day if microfilaremic or 50 mg/day if amicrofilaremic, divided into 2-3 doses; dosage doubled every day until 400 mg/day (or 8-10 mg/kg/day) is reached, lasting 3-4 weeks

Albendazole (Albenza)

Has microfilaricidal effects. For treatment of symptomatic loiasis with parasitemia of over 30,000 mf/mL to reduce level to less than 2000 microfilariae/mL prior to treatment with DEC.

Dose: 200 mg orally twice daily for 21 days.

Ivermectin (Stromectol)

Has microfilaricidal effects. For treatment of symptomatic loiasis with parasitemia between 2000 and 30,000 mf/mL to reduce level to less than 2000 microfilariae/mL prior to treatment with DEC.

Dose: 150 µg/kg, repeated at intervals of 1-3 months, as needed

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