The chemotherapy of onchocerciasis VI

Abstract

Thirty-eight patients with onchocerciasis who were treated with diethylcarbamazine (DEC) were entered into one of two randomized double-blind studies using indomethacin or cyproheptadine, or their matching placebos, in order to try to alleviate the reactions to treatment. Twenty patients received cyproheptadine (or placebo) in a dose of 4 mg three times daily for eight days, starting one day prior to DEC therapy. The remaining patients received indomethacin, 25 mg (or placebo) two capsules initially and then four further doses of 25 mg over the next 36 hours. The reactions to treatment were quantified using a recently described scoring system.

DEC reduced the microfilarial skin snip count by 96–98% in all treatment groups and treatment with indomethacin or cyproheptadine did not interfere with the microfilaricidal action of DEC.

Neither cyproheptadine nor indomethacin apparently reduced the severity of the reactions following the use of DEC in patients with onchocerciasis. We conclude that release of prostaglandins, histamine and serotonin are not primarily involved in the production of the Mazzotti reaction.