# Filariasis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Filariasis - StatPearls - NCBI Bookshelf (NBK556012) - https://www.ncbi.nlm.nih.gov/books/NBK556012/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.02 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Filariasis - disease-level clinical article (filariasis-full.txt) - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Filariasis - disease-level clinical article (filariasis-full.txt) ## Treatment metadata - Recognise and refer (Referral & Advice) - Ivermectin — 6 mg — oral.solid - Doxycycline — 100 mg — oral.solid - Albendazole — 200 mg — oral.solid ## Complete treatment card ```text FILARIASIS Sources: Filariasis - StatPearls - NCBI Bookshelf (NBK556012) - https://www.ncbi.nlm.nih.gov/books/NBK556012/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.02 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Filariasis - disease-level clinical article (filariasis-full.txt) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - Only around a third of infected people ever develop noticeable symptoms, usually as adolescents or adults once the worm burden has built up - Acute attacks bring sudden, painful groin lymph node swelling, inflammation of the testicle, spermatic cord, and epididymis, and limb swelling that spreads outward from the nodes, unlike a local bacterial infection [lymphadenopathy] - Each bout settles within 4 to 7 days and the overlying skin peels afterward, recurring 1 to 4 times a year - The lung form brings dry cough, night-time coughing spells, wheeze, breathlessness, poor appetite, malaise, and weight loss [breathlessness · cough · malaise · poor appetite · weight loss · wheeze] - Long-standing disease progresses from pitting swelling to firm, non-pitting swelling with skin thickening, darkening, and roughening - Milky urine can occur when intestinal lymph leaks into the renal pelvis and passes into the urine - In loiasis, transient, non-red swellings on the face or limbs usually clear within 2 to 4 days, sometimes preceded by pain, itching, or hives [itching · urticaria] - A patient may notice a worm visibly moving across the eye, with brief swelling and irritation until it passes through - Onchocerciasis affects the skin with itching, papules, thickened leathery skin and altered pigmentation [itching · papules] - Microfilariae migrating through the eye damage it and bring progressive loss of vision [loss of vision] - Mansonellosis is usually silent, but can bring fever, itching, tender lymph nodes, lumps under the skin and abdominal pain [abdominal pain · fever · itching] - Years of repeated inflammation end in chronic lymphoedema and elephantiasis, with permanent oedema of the limbs, the breasts, the vulva and the scrotum [oedema] SIGNS - what you find (7) - Even without symptoms, findings can include dilated lymphatics, poor lymph drainage, scrotal lymphatic changes, and blood or protein detected in the urine - Liver and spleen enlargement occur in roughly 15 percent of the lung-involvement form - Enlarged lymph nodes in the groin and armpit are found in the chronic form of the disease [lymphadenopathy] - A hydrocele, one- or two-sided, develops with chronic disease, most often tied to W bancrofti infection - Onchocerciasis shows subcutaneous nodules, eye changes, itching, and skin disease [itching] - Subcutaneous dirofilariasis typically appears as a red, tender nodule near the eye, genitals, or a limb, sometimes with an abscess forming [abscess · skin nodule] - An onchocercoma is a nodule under the skin, and they sit over bony prominences [skin nodule] TESTS (6) - Confirming the diagnosis needs circulating filarial antigen, microfilariae or filarial DNA in blood, or adult worms found in the lymphatics - Eosinophil counts often exceed 3000 per microliter, and IgE, protein, and blood in the urine can also be raised - The circulating antigen assay is the preferred test for W bancrofti and beats microscopy on sensitivity, but can false-positive with a heavy Loa loa load - Blood is best drawn between 10pm and 2am to catch Bancroftian or Brugian microfilariae, and 10am to 2pm for suspected Loa loa, matching each species' active period - Skin snips are unreliable in early infection, since a worm takes 9 to 15 months to mature enough to shed detectable microfilariae - Ultrasound can directly show live adult worms moving inside the lymphatic vessels, confirming active infection IF NOT THIS - what else fits (5) - Post-streptococcal glomerulonephritis and allergic bronchopulmonary aspergillosis are also considered - Bacterial lymphangitis and cutaneous larva migrans are on the differential - Idiopathic hypereosinophilic syndrome is also on the differential - Lymphoma and a nonfilarial hydrocele are also considered - Lymphatic damage from a prior surgery or radiation can mimic this picture Source StatPearls "Filariasis" - disease-level clinical article Status traced to the source above Rx: Main treatment | Onchocerciasis (river blindness) - treatment of choice, single dose repeated | Lymphatic filariasis with onchocerciasis - first-line, paired with ivermectin | Loiasis with a high microfilarial load, and the additional alternative in lymphatic filariasis MAIN TREATMENT 1. RECOGNISE AND REFER (REFERRAL & ADVICE) [1st line] Adult Umbrella term for infection with filarial nematodes. Egypt's own Nile Delta focus (lymphatic filariasis) has been declared eliminated as a public health problem, so a genuinely new Egyptian case is very unlikely - but a Cairo practice sees returning travellers and migrants, and chronic lymphoedema, hydrocele or acute adenolymphangitis in a patient from a previously endemic Delta village still needs recognising. Confirm the species and the microfilarial count before any drug: that is what decides the treatment, and getting it wrong can kill. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Umbrella term for infection with filarial nematodes. Egypt's own Nile Delta focus (lymphatic filariasis) has been declared eliminated as a public health problem, so a genuinely new Egyptian case is very unlikely - but a Cairo practice sees returning travellers and migrants, and chronic lymphoedema, hydrocele or acute adenolymphangitis in a patient from a previously endemic Delta village still needs recognising. Confirm the species and the microfilarial count before any drug: that is what decides the treatment, and getting it wrong can kill. Caution Rare in Egyptian primary care. Species and microfilarial count are established by a tropical-medicine service before any antifilarial is given - anyone coming from a region where onchocerciasis or loiasis is endemic is tested for coinfection first. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) The drug rows below are the regimens that service uses, so a physician can recognise a course, understand its length, and know why the test came first. They are not a licence to treat on suspicion. RED FLAG - New lymphoedema, hydrocele or recurrent adenolymphangitis attacks: refer for parasitological and serological work-up. Fever with red, tender, ascending lymphangitis: treat as bacterial superinfection and refer. ONCHOCERCIASIS (RIVER BLINDNESS) - TREATMENT OF CHOICE, SINGLE DOSE REPEATED 2. IVERMECTIN [1st line] Adult 150 micrograms/kg as a SINGLE dose, swallowed on an empty stomach and washed down with a full glass of water. Repeat at 3-to-6-month intervals until symptoms have gone, which can mean 10 years of treatment or longer. The same 150 micrograms/kg single dose is the ivermectin half of the first-line pair for lymphatic filariasis with onchocerciasis. - One dose, repeated every 3 to 6 months while symptoms persist; the article says treatment may take 10 years or more Peds 150 mcg/kg/dose (The same 150 micrograms/kg single dose. The article states no separate paediatric regimen and no minimum age or weight; ivermectin is conventionally avoided under 15 kg, which no document held here states, so weigh the child and take specialist advice in the very small.) 3kg -> 450 mcg/dose 4kg -> 600 mcg/dose 5kg -> 750 mcg/dose 6kg -> 900 mcg/dose 7kg -> 1050 mcg/dose 8kg -> 1200 mcg/dose 9kg -> 1350 mcg/dose 10kg -> 1500 mcg/dose 11kg -> 1650 mcg/dose 12kg -> 1800 mcg/dose 13kg -> 1950 mcg/dose 14kg -> 2100 mcg/dose 15kg -> 2250 mcg/dose 16kg -> 2400 mcg/dose 17kg -> 2550 mcg/dose 18kg -> 2700 mcg/dose 19kg -> 2850 mcg/dose 20kg -> 3000 mcg/dose 21kg -> 3150 mcg/dose 22kg -> 3300 mcg/dose 23kg -> 3450 mcg/dose 24kg -> 3600 mcg/dose 25kg -> 3750 mcg/dose 26kg -> 3900 mcg/dose 27kg -> 4050 mcg/dose 28kg -> 4200 mcg/dose 29kg -> 4350 mcg/dose 30kg -> 4500 mcg/dose 31kg -> 4650 mcg/dose 32kg -> 4800 mcg/dose 33kg -> 4950 mcg/dose 34kg -> 5100 mcg/dose 35kg -> 5250 mcg/dose 36kg -> 5400 mcg/dose 37kg -> 5550 mcg/dose 38kg -> 5700 mcg/dose 39kg -> 5850 mcg/dose 40kg -> 6000 mcg/dose 41kg -> 6150 mcg/dose 42kg -> 6300 mcg/dose 43kg -> 6450 mcg/dose 44kg -> 6600 mcg/dose 45kg -> 6750 mcg/dose 46kg -> 6900 mcg/dose 47kg -> 7050 mcg/dose 48kg -> 7200 mcg/dose 49kg -> 7350 mcg/dose 50kg -> 7500 mcg/dose Source Filariasis - disease-level clinical article (filariasis-full.txt) Why Ivermectin is the article's drug of choice where onchocerciasis is the only infection present, given as a single dose of 150 micrograms/kg - one sentence carrying both the indication and the dose. It is registered in Egypt in eleven forms, IVACTIN 6 mg at 13.50 EGP for six tablets. Egypt's own lymphatic-filariasis focus in the Delta was eliminated, but a Cairo practice sees returning travellers and migrants from sub-Saharan Africa, which is who the card is for. Caution TEST FOR ONCHOCERCIASIS AND LOIASIS BEFORE TREATING - this is the sentence that kills people if it is skipped. Give diethylcarbamazine (DEC) to someone who has onchocerciasis and it can set off a severe inflammatory reaction; give either DEC or ivermectin to someone who has loiasis and it can cause an encephalopathy that kills. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) So anyone from a region where onchocerciasis or loiasis is endemic is tested for coinfection before treatment starts. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) How to take it: ivermectin is swallowed with a full glass of water, on an empty stomach, and the dose is repeated at intervals of 3 to 6 months until the symptoms are gone. That can mean 10 years of treatment, or more. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) The reaction on day 3 is expected, not an allergy. Fever, rash, dizziness, itch, aching muscles and joints, and tender lymph nodes are what ivermectin commonly produces. They are the immune system answering the Wolbachia antigens as they are released, and they usually show up around day 3 of treatment. An analgesic and an antihistamine can take the edge off. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) It does not cure. Ivermectin leaves the adult worms alive, and does not clear a parasitic infection. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) DIETHYLCARBAMAZINE (DEC) IS THE TREATMENT OF CHOICE AND IS NOT REGISTERED IN EGYPT. It kills the microfilariae and the adult worms both, and is what the article chooses for a single infection with W bancrofti, B malayi or B timori. The regimen is 6 mg/kg, taken once a day or split into 3 doses, for 12 days; where there is tropical pulmonary eosinophilia the course runs longer, 14 to 21 days. There are ZERO diethylcarbamazine products in the 25,070-product Egyptian register, so no row is written for it - the regimen is printed here so a physician who needs it knows what to ask a tropical- medicine centre for. Egypt IVACTIN 6MG 6 F.C.TABS. DELTA PHARMA 13.50 EGP (2.25/unit) IVERZINE 6MG 24 TABS. UNIPHARMA CO.... 84.00 EGP (3.50/unit) LYMPHATIC FILARIASIS WITH ONCHOCERCIASIS - FIRST-LINE, PAIRED WITH IVERMECTIN 3. DOXYCYCLINE [1st line] Adult 200 mg orally once daily for 6 weeks, given together with ivermectin 150 micrograms/kg as a single dose. It works by killing the Wolbachia endosymbiont, which is why the course is long. x 6 weeks Peds NOT for young children - doxycycline is a tetracycline and stains developing teeth; it is conventionally avoided under 8 years. The article states no paediatric filarial regimen at all. A child with filariasis goes to a tropical-medicine service. Source Filariasis - disease-level clinical article (filariasis-full.txt) Why For lymphatic filariasis with onchocerciasis the article makes the pair first-line and states both doses in one sentence: doxycycline by mouth, 200 mg once daily for 6 weeks, together with a single 150 micrograms/kg dose of ivermectin. It names doxycycline separately as the alternative in lymphatic filariasis where DEC cannot be got or cannot be given - which in Egypt is always, since no DEC product is registered. Doxycycline is on every Egyptian shelf. Caution TEST FOR ONCHOCERCIASIS AND LOIASIS BEFORE TREATING - this is the sentence that kills people if it is skipped. Give diethylcarbamazine (DEC) to someone who has onchocerciasis and it can set off a severe inflammatory reaction; give either DEC or ivermectin to someone who has loiasis and it can cause an encephalopathy that kills. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) So anyone from a region where onchocerciasis or loiasis is endemic is tested for coinfection before treatment starts. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) Why it is used at all: doxycycline is the fallback where DEC cannot be got or cannot be given. It kills microfilariae and adult worms alike by going after the Wolbachia bacteria, and it works against W bancrofti and B malayi. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) Not in pregnancy, and not in a young child. The article's note on the alternatives - that DEC is unsuitable in pregnancy, and that albendazole, though pregnancy category C, is held to be safe enough in the second and third trimesters and while breastfeeding under WHO guidance - says nothing in favour of doxycycline in pregnancy, and a tetracycline is not given then. Six weeks is the course. A short course does not clear Wolbachia and does not work. DIETHYLCARBAMAZINE (DEC) IS THE TREATMENT OF CHOICE AND IS NOT REGISTERED IN EGYPT. It kills the microfilariae and the adult worms both, and is what the article chooses for a single infection with W bancrofti, B malayi or B timori. The regimen is 6 mg/kg, taken once a day or split into 3 doses, for 12 days; where there is tropical pulmonary eosinophilia the course runs longer, 14 to 21 days. There are ZERO diethylcarbamazine products in the 25,070-product Egyptian register, so no row is written for it - the regimen is printed here so a physician who needs it knows what to ask a tropical- medicine centre for. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) LOIASIS WITH A HIGH MICROFILARIAL LOAD, AND THE ADDITIONAL ALTERNATIVE IN LYMPHATIC FILARIASIS 4. ALBENDAZOLE [2nd line] Adult Loiasis with more than 8000 microfilariae/mL: 200 mg twice daily for 21 days, to bring the burden down before anything else is given. It is also the additional alternative in lymphatic filariasis for patients who cannot take doxycycline or who have loiasis or onchocerciasis as well, where it is combined with ivermectin. x 21 days for the loiasis load-reduction course Peds The article states no paediatric filarial regimen. Albendazole is dosed elsewhere in this app for the common intestinal worms; the 21-day loiasis course is a different use and a specialist decision. Source Filariasis - disease-level clinical article (filariasis-full.txt) Why Where the count runs above 8000 microfilariae/mL the article starts with albendazole to bring the burden down - 200 mg twice a day for 21 days - and adds apheresis when the load is very high; drug, dose and duration in one sentence. It names albendazole again as the alternative in lymphatic filariasis. Eleven Egyptian products are registered, ALZENTAL 200 mg among them. It sits at line 2 because it is the load-reduction and fallback drug, not the first thing given. Caution TEST FOR ONCHOCERCIASIS AND LOIASIS BEFORE TREATING - this is the sentence that kills people if it is skipped. Give diethylcarbamazine (DEC) to someone who has onchocerciasis and it can set off a severe inflammatory reaction; give either DEC or ivermectin to someone who has loiasis and it can cause an encephalopathy that kills. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) So anyone from a region where onchocerciasis or loiasis is endemic is tested for coinfection before treatment starts. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) The microfilarial count decides the drug, not the diagnosis. Where the microfilarial load is high, DEC can produce severe inflammatory reactions - encephalitis, shock - so it is the count that settles which treatment is right. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) Counting comes before prescribing. In pregnancy: albendazole is pregnancy category C, and WHO guidance holds it to be safe enough through the second and third trimesters and while breastfeeding. First-trimester use is not covered by that sentence. Combined with ivermectin it works better - albendazole and ivermectin together suppress the microfilaraemia more effectively than either alone. (Filariasis - StatPearls - NCBI Bookshelf, NBK556012) DIETHYLCARBAMAZINE (DEC) IS THE TREATMENT OF CHOICE AND IS NOT REGISTERED IN EGYPT. It kills the microfilariae and the adult worms both, and is what the article chooses for a single infection with W bancrofti, B malayi or B timori. The regimen is 6 mg/kg, taken once a day or split into 3 doses, for 12 days; where there is tropical pulmonary eosinophilia the course runs longer, 14 to 21 days. There are ZERO diethylcarbamazine products in the 25,070-product Egyptian register, so no row is written for it - the regimen is printed here so a physician who needs it knows what to ask a tropical- medicine centre for. Egypt BENDAX 200 MG 6 TAB. SIGMA 23.00 EGP (3.83/unit) VERMIZOLE 200MG 6 TAB. AMOUN 30.00 EGP (5.00/unit) ALZENTAL 200 MG 6 F.C.TABS. EIPICO 33.00 EGP (5.50/unit) ANTIZOLE 200MG 2 TAB. ALEXANDRIA 13.00 EGP (6.50/unit) ANTIZOLE 100MG/5ML SUSP. 30ML ALEXANDRIA 19.00 EGP -> ? strength differs, ? different route - not oral solid ALZENTAL 20MG/ML SUSP. 20ML EIPICO 21.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)