{
  "schema_version": 1,
  "kind": "condition",
  "id": "lymphatic-filariasis",
  "name": "Lymphatic Filariasis (Elephantiasis)",
  "category": "chronic",
  "sources": "Bancroftian Filariasis(Archived) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK547682/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.08 - condition scope only, no dose · Egyptian National Drug Formulary - Antimicrobial 2023 (diethylcarbamazine monograph, p28)",
  "review_status": "reviewed",
  "verified_against": "Lymphatic Filariasis (Elephantiasis) - disease-level clinical article (lymphatic-filariasis-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (diethylcarbamazine monograph, p28)",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 1141,
      "generic": "Diethylcarbamazine",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 100.0,
      "adult_dose": "6 mg/kg/day, as a single dose or in 3 divided doses",
      "adult_duration": "1 or 12 days; 14 to 21 days where there is tropical pulmonary eosinophilia",
      "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (diethylcarbamazine monograph, p28)",
      "rationale": "The formulary names treatment of lymphatic filariasis as an indication for diethylcarbamazine and gives 6 mg/kg/day for it - a different and lower regimen from the 8-10 mg/kg/day it gives for loiasis, which is why the two cards do not carry the same row. The cited article says every patient should be treated even when free of symptoms, because early treatment may reverse the lymphatic damage.",
      "cautions": [
        "TEST FOR CO-INFECTION FIRST. The cited article is explicit: anyone from a region where onchocerciasis or loiasis is endemic must be checked before this drug is started. Diethylcarbamazine triggers a severe inflammatory reaction in onchocerciasis, and both it and ivermectin can cause a fatal encephalopathy in loiasis.",
        "CONTRAINDICATED IN ONCHOCERCIASIS - the formulary's only listed contraindication.",
        "WHERE MICROFILARIAE ARE IN THE BLOOD the formulary offers a dose-escalating start: 50 mg once on day 1; 50 mg three times on day 2; 100 mg three times on day 3; then 6 mg/kg/day in 3 divided doses from day 4.",
        "Treating the worm does not undo established lymphoedema. Limb hygiene, skin care and management of the swelling continue regardless."
      ],
      "peds_mgkg_low": 6.0,
      "peds_mgkg_high": 6.0,
      "peds_max_mg": null,
      "peds_basis": "day",
      "peds_unit": "mg",
      "peds_note": "6 mg/kg/day, given as one dose or split into three, for 1 or 12 days; 14 to 21 days where there is tropical pulmonary eosinophilia.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": [
        {
          "weight_kg": 10,
          "low_mg": 60,
          "high_mg": 60,
          "capped": false
        },
        {
          "weight_kg": 20,
          "low_mg": 120,
          "high_mg": 120,
          "capped": false
        },
        {
          "weight_kg": 30,
          "low_mg": 180,
          "high_mg": 180,
          "capped": false
        },
        {
          "weight_kg": 40,
          "low_mg": 240,
          "high_mg": 240,
          "capped": false
        }
      ],
      "brands": [],
      "condition_id": "lymphatic-filariasis"
    },
    {
      "id": 1142,
      "generic": "Referral & safety-netting (no drug therapy)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "Wuchereria bancrofti infection causing lymphoedema/elephantiasis and hydrocele. Historically endemic in Nile Delta governorates, but Egypt reached WHO elimination status in 2013, so new transmission is very unlikely. A GP today mainly manages chronic lymphoedema (hygiene, compression) and treats acute adenolymphangitis attacks, referring for confirmation rather than prescribing antifilarial drugs directly.",
      "adult_duration": "Refer, with advice",
      "dose_source": "No dose - referral pathway, no medicine given in primary care",
      "rationale": "Wuchereria bancrofti infection causing lymphoedema/elephantiasis and hydrocele. Historically endemic in Nile Delta governorates, but Egypt reached WHO elimination status in 2013, so new transmission is very unlikely. A GP today mainly manages chronic lymphoedema (hygiene, compression) and treats acute adenolymphangitis attacks, referring for confirmation rather than prescribing antifilarial drugs directly.",
      "cautions": [
        "Rare in Egyptian primary care.",
        "The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral.",
        "RED FLAG - Before starting treatment, test patients from endemic regions for onchocerciasis or loiasis coinfection because DEC can cause severe inflammatory reactions in onchocerciasis and DEC or ivermectin can cause fatal encephalopathy in loiasis.",
        "RED FLAG - Fever with painful ascending lymphangitis (an acute attack) is treated as bacterial superinfection, and progressive limb or scrotal swelling needs referral to rule out other causes (malignancy, venous disease) as well as filariasis."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "lymphatic-filariasis"
    }
  ]
}