Semiannual Treatment of Albendazole Alone is Efficacious for Treatment of Lymphatic Filariasis: A Randomized Open-label Trial in Cote d'Ivoire

2021 ◽  
Author(s):  
Allassane F Ouattara ◽  
Catherine M Bjerum ◽  
Méité Aboulaye ◽  
Olivier Kouadio ◽  
Vanga K Marius ◽  
...  
Keyword(s):  
Lymphatic Filariasis ◽  
Primary Outcome ◽  
Central Africa ◽  
Wuchereria Bancrofti ◽  
Bancroftian Filariasis ◽  
Loa Loa ◽  
Open Label ◽  
Treatment Groups ◽  
Open Label Trial ◽  
To Receive

Abstract Background Ivermectin (IVM) plus albendazole (ALB), or IA, is widely used in mass drug administration (MDA) programs that aim to eliminate lymphatic filariasis (LF) in Africa. However, IVM can cause severe adverse events in persons with heavy Loa loa infections that are common in Central Africa. ALB is safe in loiasis, but more information is needed on its efficacy for LF. This study compared the efficacy and safety of three years of semiannual treatment with ALB to annual IA in persons with bancroftian filariasis. Methods Adults with Wuchereria bancrofti microfilaremia (Mf) were randomized to receive either three annual doses of IA (N=52), six semiannual doses of ALB 400mg (N=45), or six semiannual doses of ALB 800mg (N=47). The primary outcome amicrofilaremia at 36 months. Findings IA was more effective for completely clearing Mf than ALB 400mg or ALB 800mg (79%, CI 67-91; vs. 48%, CI 32-66 and 57%, CI 41-73, respectively). Mean % reductions in Mf counts at 36 months relative to baseline tended to be greater after IA (98%, CI 88-100) than after ALB 400mg (88%, CI 78-98) and ALB 800mg (89%, CI 79-99) (P=0.07 and P=0.06, respectively). Adult worm nest numbers (assessed by ultrasound) were reduced in all treatment groups. Treatments were well tolerated. Interpretation Repeated semiannual treatment with ALB is macrofilaricidal for W. bancrofti and leads to sustained reductions in Mf counts. This is a safe and effective regimen that could be used as MDA to eliminate LF in areas ivermectin cannot be used.

Oral Doxycycline Compared to Intravenous Ceftriaxone in the Treatment of Lyme Neuroborreliosis: A Multicenter, Equivalence, Randomized, Open-label Trial

2020 ◽  
Author(s):  
Elisa Kortela ◽  
Mari J Kanerva ◽  
Juha Puustinen ◽  
Saija Hurme ◽  
Laura Airas ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Erythema Migrans ◽  
Lyme Neuroborreliosis ◽  
Open Label ◽  
Vas Score ◽  
Oral Doxycycline ◽  
Subjective Condition ◽  
The Mean ◽  
Open Label Trial ◽  
To Receive

Abstract Background Lyme neuroborreliosis (LNB) is often treated with intravenous ceftriaxone even if doxycycline is suggested to be noninferior to ceftriaxone. We evaluated the efficacy of oral doxycycline in comparison to ceftriaxone in the treatment of LNB. Methods Patients with neurological symptoms suggestive of LNB without other obvious reasons were recruited. The inclusion criteria were (1) production of Borrelia burgdorferi–specific antibodies in cerebrospinal fluid (CSF) or serum; (2) B. burgdorferi DNA in the CSF; or (3) an erythema migrans during the past 3 months. Participants were randomized in a 1:1 ratio to receive either oral doxycycline 100 mg twice daily for 4 weeks, or intravenous ceftriaxone 2 g daily for 3 weeks. The participants described their subjective condition with a visual analogue scale (VAS) from 0 to 10 (0 = normal; 10 = worst) before the treatment, and 4 and 12 months after the treatment. The primary outcome was the change in the VAS score at 12 months. Results Between 14 September 2012 and 28 December 2017, 210 adults with suspected LNB were assigned to receive doxycycline (n = 104) or ceftriaxone (n = 106). The per-protocol analysis comprised 82 patients with doxycycline and 84 patients with ceftriaxone. The mean change in the VAS score was −3.9 in the doxycycline group and −3.8 in the ceftriaxone group (mean difference, 0.17 [95% confidence interval, −.59 to .92], which is within the prespecified equivalence margins of −1 to 1 units). Participants in both groups improved equally. Conclusions Oral doxycycline is equally effective as intravenous ceftriaxone in the treatment of LNB. Clinical Trials Registration NCT01635530.

scholarly journals An open label trial of anakinra to prevent respiratory failure in COVID-19

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Evdoxia Kyriazopoulou ◽  
Periklis Panagopoulos ◽  
Symeon Metallidis ◽  
George N Dalekos ◽  
Garyphallia Poulakou ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Primary Outcome ◽  
Standard Of Care ◽  
Hazard Ratio ◽  
Open Label ◽  
Once Daily ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Open Label Trial ◽  
Anakinra Treatment

Background It was studied if early suPAR-guided anakinra treatment can prevent severe respiratory failure (SRF) of COVID-19.Methods 130 patients with suPAR ≥6 ng/ml were assigned to subcutaneous anakinra 100mg once daily for 10 days. Primary outcome was SRF incidence by day 14 defined as any respiratory ratio below 150 mmHg necessitating mechanical or non-invasive ventilation. Main secondary outcomes were 30-day mortality and inflammatory mediators; 28-day WHO-CPS was explored. Propensity-matched standard-of care comparators were studied.Results 22.3% with anakinra treatment and 59.2% comparators (hazard ratio, 0.30; 95%CI, 0.20-0.46) progressed into SRF; 30-day mortality was 11.5% and 22.3% respectively (hazard ratio 0.49; 95% CI 0.25-0.97). Anakinra was associated with decrease in circulating interleukin (IL)-6, sCD163 and sIL2-R; IL-10/IL-6 ratio on day 7 was inversely associated with SOFA score; patients were allocated to less severe WHO-CPS strata.Conclusions Early suPAR-guided anakinra decreased SRF and restored the pro-/anti-inflammatory balance.Trial Registration: ClinicalTrials.gov, NCT04357366

Efficacy of Low-Dose Alteplase for Treatment of Hemodialysis Catheter Occlusions

2005 ◽  
Vol 6 (2) ◽  
pp. 76-82 ◽  
Author(s):  
J. Haymond ◽  
K. Shalansky ◽  
J. Jastrzebski
Keyword(s):  
Cost Reduction ◽  
Primary Outcome ◽  
Low Dose ◽  
Financial Analysis ◽  
Blood Flow Rate ◽  
Venous Catheter ◽  
Open Label ◽  
Hemodialysis Catheter ◽  
Catheter Patency ◽  
Open Label Trial

Background Traditionally, alteplase 2 mg/lumen doses have been used to treat central venous catheter (CVC) occlusions. On January 20, 2004, our hemodialysis (HD) unit implemented a new protocol to utilize alteplase 1 mg/lumen doses for catheter occlusion. Objectives The objectives were to 1) assess the efficacy of low-dose alteplase in restoring HD catheter patency; 2) determine the duration of CVC patency as determined by need for further alteplase doses, or radiological or surgical line interventions; and 3) evaluate the financial implications of the new protocol. Methods The study was a prospective, open-label trial of 50 consecutive HD patients with permanent, tunnelled CVC lines. A treatment course consisted of 1 or 2 doses of alteplase instilled for 60 minutes then aspirated or as an overnight (48–72 hour) dwell until the next HD. The patient's first alteplase dose following implementation of the new protocol was evaluated. Patients were followed for two months to record need for further alteplase treatment courses, and four months to document radiological or surgical line interventions. The primary outcome was to assess successful restoration of catheter patency defined as the ability of alteplase to restore or maintain HD blood flow rate at or above 300 mL/minute. A financial analysis compared alteplase costs for 11 months prior to and after implementation of the new protocol. Results Alteplase 1 mg/lumen doses restored catheter patency in 72% of HD patients with one dose, increasing to 83% with a second dose. Sixty-two percent of patients required a subsequent alteplase course with a median time to next treatment of 14 days and a median of 2 courses/patient. Radiological interventions were ordered in 38% of patients resulting in 8 lines replacements and 7 line strippings. Financial savings with the new low-dose protocol were ~CDN$22,000. Conclusion Low dose alteplase 1 mg/lumen successfully treated occlusion of permanent hemodialysis catheters, with a resulting cost reduction.

scholarly journals Current Bancroftian Filariasis Elimination on Thailand-Myanmar Border: Public Health Challenges toward Postgenomic MDA Evaluation

2013 ◽  
Vol 2013 ◽  
pp. 1-13 ◽  
Author(s):  
Adisak Bhumiratana ◽  
Apiradee Intarapuk ◽  
Surachart Koyadun ◽  
Pannamas Maneekan ◽  
Prapa Sorosjinda-Nunthawarasilp
Keyword(s):  
Lymphatic Filariasis ◽  
Wuchereria Bancrofti ◽  
Local People ◽  
Epidemiological Surveillance ◽  
Border Crossings ◽  
Bancroftian Filariasis ◽  
Global Perspectives ◽  
Free Zone ◽  
Cross Border ◽  
Public Health Challenges

From regional and global perspectives, Thailand has progressed toward lymphatic filariasis transmission-free zone in almost entire endemic provinces, being verified by WHO by the end of 2012 after the 5-year implementation of mass drug administration (MDA) with diethylcarbamazine and albendazole as part of the National Program to Eliminate Lymphatic Filariasis (PELF) (2002–2006) and a 4-year expansion of post-MDA surveillance (2007–2010). However, Thai PELF has been challenging sensitive situations of not only border crossings of local people on Thailand-Myanmar border where focal distribution of forest- and forest fringe-related border bancroftian filariasis (BBF) is caused by nocturnally subperiodic Wuchereria bancrofti in local people living in pockets of endemic villages, but also intense cross-border migrations of Mon and Tanintharyi workers from Myanmar to Thailand who harbor nocturnally periodic W. bancrofti microfilaremic infection causing the emergence of imported bancroftian filariasis (IBF). Thus, this paper discusses the apparent issues and problems pertaining to epidemiological surveillance and postgenomic MDA evaluation for 2010–2020 convalescent BBF and IBF. In particular, the population migration linked to fitness of benzimidazole-resistant W. bancrofti population is a topic of interest in this region whether the resistance is associated with pressure of the MDA 2 drugs and the vulnerabilities epidemiologically observed in complex BBF or IBF settings.

scholarly journals Mapping lymphatic filariasis in Loa loa endemic health districts naïve for ivermectin mass administration and situated in the forested zone of Cameroon.

2020 ◽  
Author(s):  
Andrew A Beng ◽  
Mathias E Esum ◽  
Kebede Deribe ◽  
Abdel J Njouendou ◽  
Patrick WC Ndongmo ◽  
...  
Keyword(s):  
Lymphatic Filariasis ◽  
Positive Association ◽  
Wuchereria Bancrofti ◽  
Cross Reactivity ◽  
Molecular Techniques ◽  
Blood Collection ◽  
Loa Loa ◽  
African Region ◽  
Strong Positive Association ◽  
Health Districts

Abstract Background The control of lymphatic filariasis (LF) caused by Wuchereria bancrofti in the Central African Region has been hampered by the presence of Loa loa due to severe adverse events that arise in the treatment with ivermectin. The immunochromatographic test (ICT) cards used for mapping LF demonstrated cross-reactivity with L. loa and posed the problem of delineating the LF map. To verify LF endemicity in forest areas of Cameroon where mass drug administration (MDA) has not been ongoing, we used the recently developed strategy that combined serology, microscopy and molecular techniques. Methods This study was carried out in 124 communities in 31 health districts (HDs) where L. loa is present. At least 125 persons per site were screened. Diurnal blood samples were investigated for circulating filarial antigen (CFA) by FTS and for L. loa microfilariae (mf) using TBF. FTS positive individuals were further subjected to night blood collection for detecting W . bancrofti . qPCR was used to detect DNA of the parasites. Results Overall, 14,446 individuals took part in this study, 233 participants tested positive with FTS in 29 HDs, with positivity rates ranging from 0.0% to 8.2%. No W . bancrofti mf was found in the night blood of any individuals but L. loa mf were found in both day and night blood of participants who were FTS positive. Also, qPCR revealed that no W. bancrofti but L.loa DNA was found with dry bloodspot. Positive FTS results were strongly associated with high L. loa mf load. Similarly, a strong positive association was observed between FTS positivity and L loa prevalence. Conclusions Using a combination of parasitological and molecular tools, we were unable to find evidence of W. bancrofti presence in the 31 HDs, but L. loa instead. Therefore, LF is not endemic and LF MDA is not required in these districts.

Levofloxacin versus ceftriaxone for treatment of acute pyelonephritis in Iranian adults

2020 ◽  
Vol 20 ◽  
Author(s):  
Shabnam Tehrani ◽  
Fereshteh Elyasi ◽  
Sara Abolghasemi
Keyword(s):  
Antibiotic Resistance ◽  
Acute Pyelonephritis ◽  
Bacterial Infections ◽  
Susceptibility Testing ◽  
P Value ◽  
Open Label ◽  
Treatment Groups ◽  
Microbiological Characteristics ◽  
Open Label Trial ◽  
Resistance Rates

Introduction: Acute pyelonephritis is among the most common bacterial infections. Options for initial treatment of pyelonephritis include an extended-spectrum cephalosporin or a fluoroquinolone. In this study, we aimed to compare the clinical outcomes of patients receiving ceftriaxone to those who received levofloxacin for the treatment of acute pyelone-phritis. Methods: In this randomized, open-label trial, hospitalized adults with acute pyelonephritis were treated with ceftriaxone (1g IV every 12 hours) or levofloxacin (750 mg IV daily) for at least 7 days. Clinical and microbiological characteristics were compared among patients treated with ceftriaxone and levofloxacin. Results: A total of 59 patients were randomized, 30 to the ceftriaxone group and 29 to the levofloxacin group. The clinical response for 68.0% of patients in the ceftriaxone group and 56.0% of patients in the levofloxacin group were cured. The mi-crobiological response (pathogen eradication rates) was 68.7% in the ceftriaxone group and 21.4% in the levofloxacin group.(P value=0.00028) Escherichia coliwas the most common pathogen (n = 31), followed by Klebsiella pneumoniae(n = 21). High resistance rates were detected for cotrimoxazole (55%), ciprofloxacin (48%), and ceftriaxone (34.4%) in isolat-ed E.coli. Likewise, all K. pneumoniaeisolates were resistant to ciprofloxacin. Conclusions: Our study indicates that ceftriaxone was more effective than levofloxacin in the treatment of acute pyelone-phritis, on the basis of microbiological response, but there were no statistically significant differences between the treatment groups in the rates of clinical cure.The resistance of uropathogens to the most used antibiotics was relatively high. Choosing the treatment regimen based on susceptibility testing results and shortening the duration of the therapy are now recommend-ed to be the most important approaches to decrease the spread of antibiotic resistance worldwide.

scholarly journals Imported Asymptomatic Bancroftian Filariasis Discovered from a Plasmodium vivax Infected Patient: A Case Report from Singapore

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Jean-Marc Chavatte ◽  
Roland Jureen
Keyword(s):  
Case Report ◽  
Lymphatic Filariasis ◽  
Plasmodium Vivax ◽  
Laboratory Finding ◽  
Dna Amplification ◽  
Wuchereria Bancrofti ◽  
Bancroftian Filariasis ◽  
Public Health Importance ◽  
Imported Case ◽  
Vector Borne

Human lymphatic filariasis is a vector-borne disease mainly caused by the parasitic nematode Wuchereria bancrofti and transmitted worldwide within the tropical and subtropical regions. Singapore was once endemic for bancroftian filariasis but recent reports are scarce and the disease is nearly forgotten. The case report presented here reports the incidental hospital laboratory finding of an asymptomatic microfilaremia in a relapsing Plasmodium vivax imported case during a malaria treatment follow-up appointment. The parasite was identified by microscopy as W. bancrofti and retrospective investigation of the sample collected during malaria onset was found to be also positive. Additional confirmation was obtained by DNA amplification, sequencing, and phylogenetic analysis of the mitochondrial cox1 gene that further related the parasite to W. bancrofti strains from the Indian region. Considering the large proportion of asymptomatic filariasis with microfilaremia, the high number of migrants and travellers arriving from the surrounding endemic countries, and the common presence of local competent mosquito vectors, Singapore remains vulnerable to the introduction, reemergence, and the spread of lymphatic filariasis. This report brings out from the shadow the potential risk of lymphatic filariasis in Singapore and could help to maintain awareness about this parasitic disease and its public health importance.

scholarly journals An open label, randomized clinical trial to compare the tolerability and efficacy of ivermectin plus diethylcarbamazine and albendazole vs. diethylcarbamazine plus albendazole for treatment of brugian filariasis in Indonesia

2021 ◽  
Vol 15 (3) ◽  
pp. e0009294
Author(s):  
Taniawati Supali ◽  
Yenny Djuardi ◽  
Michael Christian ◽  
Elisa Iskandar ◽  
Rahmat Alfian ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Drug Combination ◽  
Membrane Filtration ◽  
Wuchereria Bancrofti ◽  
Open Label ◽  
Safety And Efficacy ◽  
Treatment Groups ◽  
Administration Regimen ◽  
Filarial Antigen ◽  
One Year

Improved treatments for lymphatic filariasis (LF) could accelerate the global elimination program for this disease. A triple drug combination of the anti-filarial drugs ivermectin, diethylcarbamazine (DEC) and albendazole (IDA) has been shown to be safe and effective for achieving sustained clearance of microfilariae (Mf) of the filarial parasite Wuchereria bancrofti from human blood. However, the triple drug combination has not been previously been evaluated for treatment of brugian filariasis, which accounts for about 10% of the global LF burden. This hospital-based clinical trial compared the safety and efficacy of IDA with that of the standard treatment (DEC plus albendazole, DA) in persons with Brugia timori infections on Sumba island, Indonesia. Fifty-five asymptomatic persons with B. timori Mf were treated with either a single oral dose of IDA (28 subjects) or with DEC plus albendazole (DA, 27 subjects). Participants were actively monitored for adverse events (AE) for two days after treatment by nurses and physicians who were masked regarding treatment assignments. Passive monitoring was performed by clinical teams that visited participant’s home villages for an additional five days. Microfilaremia was assessed by membrane filtration of 1 ml night blood at baseline, at 24h and one year after treatment. IDA was more effective than DA for completely clearing Mf at 24 hours (25/28, 89% vs. 11/27, 41%, P < 0.001). By 12 months after treatment, only one of 28 IDA recipients had Mf in their blood (4%) vs. 10 of 27 (37%) in persons treated with DA (P = 0.002). Approximately 90% of participants had antibodies to recombinant filarial antigen BmR1 at baseline. Antibody prevalence decreased to approximately 30% in both treatment groups at 12 months. About 45% of persons in both treatment groups experienced AE such as fever, muscle aches, lower back, joint and abdominal pain. These were mostly mild and most common during the first two days after treatment. No participant experienced a severe or serious AE. This study showed that IDA was well-tolerated and significantly more effective for clearing B. timori Mf from the blood than DA. Larger studies should be performed to further assess the safety and efficacy of IDA as a mass drug administration regimen to eliminate brugian filariasis. Trial Registration: NCT02899936.

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