Diethylcarbamazine (DEC) is the drug of choice in the United States. The drug kills the microfilariae and some of the adult worms. DEC has been used world-wide for more than 50 years. Because this infection is rare in the U.S., the drug is no longer approved by the Food and Drug Administration (FDA) and cannot be sold in the U.S. Physicians can obtain the medication from CDC after confirmed positive lab results. CDC gives the physicians the choice between 1 or 12-day treatment of DEC (6 mg/kg/day). One day treatment is generally as effective as the 12-day regimen. DEC is generally well tolerated. Side effects are in general limited and depend on the number of microfilariae in the blood. The most common side effects are dizziness, nausea, fever, headache, or pain in muscles or joints.
DEC should not be administered to patients who may also have onchocerciasis as DEC can worsen onchocercal eye disease. In patients with loiasis, DEC can cause serious adverse reactions, including encephalopathy and death. The risk and severity of the adverse reactions are related to Loa loa microfilarial density.
In settings where onchoceriasis is present, Ivermectin is the drug of choice to treat LF.
Some studies have shown adult worm killing with treatment with doxycycline (200mg/day for 4–6 weeks).
People with lymphedema and elephantiasis are unlikely to benefit from DEC treatment because most people with lymphedema are not actively infected with the filarial parasite.
To prevent lymphedema from getting worse, patients should ask their physician for a referral to a lymphedema therapist so they can be informed about some basic principles of care such as hygiene, elevation, exercises,skin and wound care, and wearing appropriate shoes.
Patients with hydrocele may have evidence of active infection, but typically do not improve clinically following treatment with DEC. The treatment for hydrocele is surgery.
There is some evidence that suggests that a course of the antibiotic doxycycline may prevent lymphedema from getting worse.