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Decrease in adverse reactions after repeated ivermectin treatment in onchocerciasis

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Abstract

We assessed the side-effects after multiple single-dose treatment with ivermectin (150μg/kg) in onchocerciasis patients from a hyperendemic area in Sierra Leone, in order to investigate whether medical surveillance was always necessary.

After initial treatment 87 onchocerciasis patients were examined for adverse reactions. Fourty-four of these 87 patients (51%) received a second dose of invermectin 5 months later and thirty-five (40%) received a third dose one year later.

The side-effects after the second and third doses were significantly diminished, when compared with the initial dose of ivermectin in the treatment of onchocerciasis (χ 2 test p < 0.005, resp. p < 0.008). Side-effects requiring therapy were observed in 32% of patients after the first dose, in 18% after the second dose and in 11% after the third dose of ivermectin. Severe side-effects (9%) were only seen after the initial ivermectin dose. All the severe adverse reactions appeared within 48 hours. In view of our findings, it seems necessary that the first treatment with invermectin should take place under strict medical supervision during at least two days.

Five months after treatment with a single dose of invermectin 29 out of 44 patients (66%) still had a positive skin-snip test. Seven months after the second dose 15 of 35 patients (43%) had a positive skin-snip count. Since almost half of the patients had a positive skin-snip test despite two treatments with ivermectin, it could be argued that in hyperendemic areas treatment should consist of at least two doses in the first year.

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Authors and Affiliations

  1. Department of Ophthalmology, Free University Amsterdam, Amsterdam, The Netherlands

    A. Van Der Lelij

  2. Department of Ophthalmology, University of Amsterdam, Amsterdam, The Netherlands

    A. Rothova

  3. Department of Ophthalmo-Immunology, The Netherlands Ophthalmic Research Institute, Amsterdam, The Netherlands

    A. Rothova

  4. F.C. Danders Institute of Ophthalmology, Utrecht, The Netherlands

    N. Klaassen-Broekema & J. S. Stilma

  5. Eye Hospital Lunsar, Sierra Leone, West Africa

    W. R. Wilson & R. F. Barbe

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  1. A. Van Der Lelij
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  2. A. Rothova
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  3. N. Klaassen-Broekema
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  4. W. R. Wilson
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  5. R. F. Barbe
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  6. J. S. Stilma
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Van Der Lelij, A., Rothova, A., Klaassen-Broekema, N. et al. Decrease in adverse reactions after repeated ivermectin treatment in onchocerciasis. Doc Ophthalmol 75, 215–224 (1990). https://doi.org/10.1007/BF00164834

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