Albendazole, combined with ivermectin

W. bancrofti, the efficacy of a single dose of albendazole 600 mg alone or in combination with ivermectin 400 pg/kg or diethylcarbamazine 6 mg/kg was compared with a single dose of the combination diethylcarbamazine 6 mg/kg and ivermectin 400 pg/kg over a period of 15 months after treatment. Albendazole plus ivermectin was the most effective regimen for clearing microfilariae. Nine of 13 subjects (69%) were amicrofilaremic 15 months after treatment compared... 

Knopp S, Mohammed KA, Speich B, Hattendorf J, Khamis IS, Khamis AN, Stothard JR, Rollinson D, Marti H, Utzinger J. Albendazole and mebendazole administered alone or in combination with ivermectin against Trichuris trichiura a randomized controlled trial. Clin Infect Dis 2010 51 1420-8. 

As antihehninthic drugs go, ivermectin can be considered a reasonably safe drug, and it is generally better tolerated than diethylcarbamazine. Clinical experience has often shown relatively little toxicity, although mild adverse effects, presumably due to the kilting of the microfilariae, involve at least one-third of patients some work has suggested that neutrophil activation may play a role in the development of these reactions (1). It has also been well tolerated in combinations, for example when given with albendazole in order to kill adult worms (which cannot be achieved with ivermectin alone) or with diethylcarbamazine for bancroftian filariasis (SEDA-20, 281). 

Early-stage elephantiasis caused by bancroftian filariasis in a 27-year-old traveller was treated with a single-dose oral combination of ivermectin 24 mg plus albendazole 400 mg, followed by albendazole 800 mg for 21 days (14). To avoid a severe Mazzotti-like reaction, he was given oral glucocorticoids and antihistamines for 3 days. He had a transient rash, pruritus, and mild hypotension on the days after the initial treatment, but otherwise remained well and the swelling subsided. Within 1 month he was free of symptoms. At the last follow-up examination, 3 years after treatment, there was no clinical or laboratory evidence of relapse. The authors thought that this type of treatment should be evaluated on a wider scale, given the minimal adverse events and apparent therapeutic efficacy. 

W. bancwfti than ivermectin alone. Because albendazole has broad potency against intestinal helminths, combination therapy with ivermectin and albendazole would carry the added advantage of reducing the prevalence and intensity of filarial parasites as well as of intestinal nematodes. 

The efficacy of ivermectin for human onchocerciasis was established in the 1980s and is summarized in this chapter briefly. Clinical study of ivermectin in human strongyloidiasis has not yet been completed. Here we describe the efficacy of ivermectin for human strongyloidiasis as observed in our institution during the past decade. Furthermore, we would like to describe the combination therapy with ivermectin and albendazole for bancroftian filariasis and also the efficacy of ivermectin in the treatment of human scabies. 

Combined treatment with ivermectin and albendazole for bancroftian filariasis was more effective than treatment with ivermectin alone. In tropical countries where bancroftian filariasis is endemic, infection with intestinal helminths is also an important public health concern. Additional benefits of this combination are its potent, broad-spectrum activity against intestinal helminths and potential relative safety. 

Albendazole is combined with either diethylcarbamazine or ivermectin in programs directed toward controlling LF. By annual dosing with combination therapy for 4-6 years, the goal is to maintain the microfilaremia at such low levels that transmission cannot occur for a period that corresponds to the duration of fecundity of adult worms. Albendazole is given with diethylcarbamazine to control LF in most parts of the world. To avoid serious reactions to dying microfilariae, an albendazole/ivermectin combination is recommended in locations where filaiiasis coexists with either onchocerciasis or loiasis. 

Shenoy RK, Dalia S, John A et al. (1999) Treatment of the mi-crofilaraemia of asymptomatic brugian filariasis with single doses of ivermectin, diethylcarbamazine or albendazole, in various combinations. Ann Trop Med Parasitol 93 643-651... 

Veraldi S, Francia C, La Vela V, Nazzaro G, Barbareschi M. Telogen effluvium after oral albendazole. Clin Exp Dermatol 2012 37 562-73. Sinha P, Garg A, Prakash O, Desai NG. Drug-induced psychosis associated with albendazole-ivermectin combination therapy. Gen Hosp... 

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