东南亚超过一半的丝虫病病例是由马来布鲁线虫(Brugia malayi)引起的（Flickr/AJC1）

        科学家说，一种常用抗生素最适于清除东南亚最常见的淋巴丝虫病。导致象皮病的淋巴丝虫病是由班氏吴策线虫(Wuchereria bancrofti）和马来布鲁线虫(Brugia malayi)引起的。它们寄生在淋巴系统内，阻塞淋巴管，导致令人虚弱的肿大。

        标准的疗法是乙胺嗪和阿苯达唑联合用药，但是它们会导致诸如发热、头疼、眩晕和淋巴结肿大等副作用。人们已知强力霉素可以有效对抗班氏吴策线虫，但是东南亚超过一半的病例是由马来布鲁线虫引起的。

        这组科学家在印尼用强力霉素、乙胺嗪或阿苯达唑对161名成年参与者进行了治疗，治疗组和对照组都治疗了6周时间。他们发现77%的接受强力霉素的患者在1年后马来布鲁线虫检测呈阴性，而接受了乙胺嗪和阿苯达唑的患者的这个数字只有27%。强力霉素的副作用也最低。

        该研究的主要参与者、印度尼西亚大学寄生虫学系Taniawati Supali说：“由于该疗法是在6周的疗程内每天服用100毫克强力霉素，我们不建议印度尼西亚政府把强力霉素作为大规模疗法。”

        Supali说在印度尼西亚用强力霉素消除丝虫病的最大障碍是许多患者生活在远离医疗中心的地方，而且可能无法遵守取药和每天服药的做法。她说：“我担心如果患者无法服用剂量正确的强力霉素，寄生虫将获得比此前更多的耐药性。”

        印度尼西亚卫生部国家丝虫病消除计划的一个团队负责人Sekartuti说：“印度尼西亚现在使用的是一种基于社区的策略，每年口服1剂乙胺嗪，连续服用5年。”但是她同意强力霉素最适于那些能自觉服药和更容易获取卫生保健的人们的治疗。

        Sekartuti估计印度尼西亚患有丝虫病的人数大约是1000万，而1.5亿印度尼西亚人生活在丝虫病流行地区。该研究发表在了《临床传染病》杂志的5月号上。

原始出处：（Clinical Infectious Diseases），2008;46:1385–1393 DOI: 10.1086/586753，Taniawati Supali, Erliyani Sartono

Doxycycline Treatment of Brugia malayi–Infected Persons Reduces Microfilaremia and Adverse Reactions after Diethylcarbamazine and Albendazole Treatment

Taniawati Supali,1 Yenny Djuardi,1 Kenneth M. Pfarr,4 Heri Wibowo,1 Mark J. Taylor,5 Achim Hoerauf,4 Jeanine J. Houwing-Duistermaat,3 M. Yazdanbakhsh,2 and Erliyani Sartono2

1Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Departments of 2Parasitology and 3Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands; 4Institute for Medical Microbiology, Immunology, and Parasitology, University of Bonn, Bonn, Germany; and 5Liverpool School of Tropical Medicine, Liverpool, United Kingdom

Background.  The efficacy of doxycycline for treating the causal agent of human lymphatic filariasis, Brugia malayi, is unknown. Standard treatment with diethylcarbamazine-albendazole is associated with adverse reactions. We assessed whether doxycycline alone or in combination with diethylcarbamazine-albendazole would lead to sustained amicrofilaremia and reduced incidence of adverse reactions.

Methods.  A double-blind, randomized, placebo-controlled 6-week field trial of doxycycline treatment (100 mg/day) of 161 persons infected with B. malayi was conducted. Four months after receiving doxycycline ( ) or placebo ( ), participants received diethylcarbamazine (6 mg/kg) plus albendazole (400 mg) or a matching placebo. Adverse reactions were assessed 48 and 60 h after administration of diethylcarbamazine-albendazole. Treatment efficacy was evaluated at 2, 4, and 12 months after the initial doxycycline treatment.

Results.  Four months after beginning doxycycline treatment, Wolbachia loads were reduced by 98%. Doxycycline treatment reduced the prevalence of microfilaremia at 2, 4, and 12 months of follow-up ( for all time points). At the 1-year follow-up, prevalence was reduced by 77% and 87.5% in patients receiving doxycycline alone or doxycycline plus diethylcarbamazine-albendazole, respectively. In contrast, the reduction of microfilaremia in the group receiving placebo doxycycline plus diethylcarbamazine-albendazole was merely 26.7%. Adverse reactions were lowest in the group receiving doxycycline plus placebo diethylcarbamazine-albendazole and highest in the group receiving placebo doxycycline plus diethylcarbamazine-albendazole. The proportion of persons with high fever and severe adverse reactions was significantly reduced in the group treated with doxycycline plus diethylcarbamazine-albendazole.

Conclusions.  A 6-week course of doxycycline, either alone or in combination with diethylcarbamazine-albendazole, leads to a decrease in microfilaremia and reduces adverse reactions to antifilarial treatment in B. malayi–infected persons.