Table 1 Recommendations for the treatment of loiasis

Guidelines

 Endemic

 < 2000 mf/ml, adults*:

Diethylcarbamazine 200 mg twice daily for 28 days (gradual dose increase from 6 mg twice daily), second course four weeks later if needed

 < 2000 mf/ml, children*:

Diethylcarbamazine 1.5 mg/kg twice daily for 28 days (from gradual dose increase)

 < 8000 mf/ml:

Ivermectin 150 μg/kg single-dose, monthly repeat if needed, then diethylcarbamazine

 < 30,000 mf/ml, diethylcarbamazine failure or contraindication:

Ivermectin 150 μg/kg single-dose, monthly or quarterly repeat if needed

 > 30,000 mf/ml:

Possibly albendazole 200 mg twice daily for 21 days, then ivermectin 150 μg/kg once daily for five days (inpatient), then diethylcarbamazine

Eye migration:

Surgical removal not recommended

Adjunct therapy:

Paracetamol for first seven days for treatment of hypermicrofilaremic infection

Médecins Sans Frontières

[14], 2024

 Germany: travellers and migrants

Diethylcarbamazine 3 mg/kg three times daily for 21 days, repeat if needed

Or albendazole 400 mg twice daily for 28 days

Or albendazole, then ivermectin 150–200 µg/kg single-dose

 < 2000 mf/ml:

Diethylcarbamazine (gradual dose increase from 50 mg/d)

Or albendazole

Or albendazole, then ivermectin

 < 8000 mf/ml:

Albendazole, then diethylcarbamazine

Or ivermectin, then diethylcarbamazine

Or albendazole, then ivermectin, then diethylcarbamazine

 < 30,000 mf/ml:

Possibly apheresis, then ivermectin or albendazole or diethylcarbamazine

Or albendazole 400 mg once or twice daily for 28 days, then ivermectin or diethylcarbamazine

 > 30,000 mf/ml:

Apheresis, then ivermectin or albendazole or diethylcarbamazine

Or albendazole (unclear dosage)

Prophylaxis:

Diethylcarbamazine 300 mg weekly

Adjunct therapy:

Possibly antihistamines or corticosteroids

Association of the Scientific Medical Societies in Germany

[7], 2024

 Endemic, and travellers and migrants

Diethylcarbamazine 3 mg/kg three times daily for 21 days†,

 < 2500 mf/ml, O. volvulus coinfection:

Ivermectin inconclusive recommendation

Diethylcarbamazine for 21 days (gradual dose increase from 50 to 1 mg/kg), possibly after pre-therapy, repeat if needed†

 > 2500 mf/ml or diethylcarbamazine failure, and symptomatic:

Albendazole 200 mg twice daily for 21 days, repeat if needed, then diethylcarbamazine

 > 2500 mf/ml and symptomatic:

Apheresis, then diethylcarbamazine

Prophylaxis:

Diethylcarbamazine 300 mg weekly

Eye migration:

Surgical removal only for diagnostic purposes or intraocular worm

Adjunct therapy:

Possibly concomitant corticosteroids or antihistamines

UpToDate

[9], 2022

 UK: travellers and migrants

Diethylcarbamazine‡ 200 mg three times daily for 21 days (gradual dose increase from 50 mg daily)

 < 1000 mf/ml:

Diethylcarbamazine‡

 > 1000 mf/ml:

Albendazole 200 mg twice daily for 21 days, then diethylcarbamazine

Adjunct therapy:

prednisolone 30 mg once daily for 7 days, starting the day before diethylcarbamazine

UK guideline [8], 2024

 USA: endemic, and travellers and migrants

Laboratory-confirmed loiasis < 8000 mf/ml:

Diethylcarbamazine, 2.7 to 3.3 mg/kg three times daily for 21 days, repeat if needed ‡

 > 8000 mf/ml or diethylcarbamazine failure:

Albendazole 200 mg twice daily for 21 days, possibly also apheresis, then diethylcarbamazine

 > 8000 mf/ml:

Apheresis, possibly also albendazole, then diethylcarbamazine

Prophylaxis:

Diethylcarbamazine 300 mg once weekly

Merck Sharp & Dohme manual

[11], 2022

 Gabon: endemic

 < 8000 mf/ml:

Ivermectin 200 μg/kg daily for 10 days

 > 8000 mf/ml:

Albendazole 800 mg daily for 10 days

Mass treatment:

Unknown population microfilaremia:

Albendazole 400 mg daily for 21 days

Population microfilaremia

 < 8000 mf/ml:

Ivermectin 200 μg/kg single dose

Population microfilaremia > 8000 mf/ml:

Albendazole 400 mg daily for 21 days

Adjunct therapy:

Concomitant corticosteroids (e.g., prednisone 0.5 mg/kg for 5 days)

Gabonese health ministry

[6], year unknown

 USA: travellers and migrants

 < 8000 mf/ml and symptoms:

Diethylcarbamazine 2.7–3.3 mg/kg three times daily for 21 days, one or two courses‡

 < 8000 mf/ml and diethylcarbamazine failure (twice) or contraindication:

Albendazole 200 mg twice daily for 21 days§

 > 8000 mf/ml and symptoms:

Apheresis or albendazole, then diethylcarbamazine

Adjunct therapy:

possibly concomitant corticosteroids or antihistamines

U.S. Centers for Disease Control and Prevention

[12], 2020

 USA: endemic, and travellers and migrants

Diethylcarbamazine 400 mg daily (or 8–10 mg/kg per day) for 21–28 days (gradual dose increase from 50 mg daily), divided into 2–3 doses, repeat if needed

 < 2000 mf/ml:

Diethylcarbamazine 400 mg daily (or 8–10 mg/kg per day) for 21–28 days (gradual dose increase from 3 or 6 mg daily), divided into 2–3 doses, repeat if needed

Or albendazole 200 mg twice daily for 21 days or ivermectin

 < 8000 mf/ml:

Ivermectin 150 µg/kg single dose, repetition every 1–3 months, if needed, then diethylcarbamazine

 < 30,000 mf/ml:

Ivermectin or albendazole, then diethylcarbamazine

 > 30,000 mf/ml:

Albendazole or apheresis, then diethylcarbamazine

Prophylaxis:

Diethylcarbamazine 300 mg once weekly or 200 mg twice daily for 3 days monthly

Eye migration:

Surgical removal

Adjunct therapy:

Possibly concomitant antihistamines or corticosteroids

Medscape

[10], 2020

 France: endemic, and travellers and migrants

 < 30,000 mf/ml:

Diethylcarbamazine for several weeks

 < 30,000 mf/ml:

Ivermectin single dose, after albendazole pre-therapy

Albendazole, then diethylcarbamazine or ivermectin

French health ministry

[33], 2018

Reviews

 Endemic, and travellers and migrants

Diethylcarbamazine 9 mg/kg in three divided doses daily for 21 days, repeat if necessary

Or albendazole 400 mg twice daily for 28 days, possibly followed by ivermectin 150–200 µg/kg single dose

 < 2000 mf/ml:

diethylcarbamazine (gradual dose increase, starting dose 50 mg), repeat if necessary

Or albendazole, possibly followed by ivermectin

 < 8000 mf/ml:

Albendazole, possibly followed by diethylcarbamazine

Or ivermectin followed by diethylcarbamazine

Or albendazole, followed by ivermectin, possibly followed by diethylcarbamazine

 < 30,000 mf/ml:

Albendazole, possibly followed by ivermectin, possibly followed by diethylcarbamazine

 > 30,000 mf/ml:

Apheresis, followed by chemotherapy

Or albendazole, followed by chemotherapy

Adjunct treatments: possibly antihistamines and corticosteroids

[1], 2024

 Italy: travellers and migrants

 < 8000 mf/ml:

Diethylcarbamazine 8–10mg/kg per day in divided doses for 21 days, possibly one repetition, then albendazole

Or possibly imatinib‡

Co-infection with onchocerciasis:

Ivermectin 150 µg/kg single dose

 > 8000 mf/ml:

Albendazole 200 mg twice daily for 21 days, then diethylcarbamazine

Or apheresis

Or possibly imatinib

Adjunct treatments:

Prednisone (start with 60 mg/d)

Mention of reslizumab

[21], 2022

 Endemic, and travellers and migrants

No threshold:

Albendazole 800 mg daily for 28 days, then ivermectin

Or mebendazole 300–1500 mg daily for 21 days, then ivermectin or diethylcarbamazine

[31], 2021

 Endemic, and travellers and migrants

Across populations: diethylcarbamazine (most frequently), mebendazole,

And imatinib

 < 8000 mf/ml:

Ivermectin

 > 8000 mf/ml:

albendazole

[17], 2019

 USA: travellers and migrants

 < 8000 mf/ml:

Diethylcarbamazine

 > 8000 mf/ml:

Adjunct/second-line cytapheresis, then diethylcarbamazine

[32], 2018

 Endemic, and travellers and migrants

 < 20,000–30,000 mf/ml:

Diethylcarbamazine or ivermectin

 > 20,000–30,000 mf/ml:

albendazole, then ivermectin

[34], 2018

 France/travellers and migrants

Diethylcarbamazine 400 mg/d divided in 2–3 daily doses for 21 to 28 days (progressive dose increase from 50 mg/d), repeat if needed, possibly followed by albendazole 200 mg twice daily for 21 days

 < 2000 mf/ml:

Diethylcarbamazine 400 mg/d divided in 2–3 daily doses for 21 to 28 days (progressive dose increase from 3–6 mg/d), repeat if needed, possibly followed by albendazole 200 mg twice daily for 21 days

 < 8000 mf/ml:

Ivermectin 150 µg/kg single dose. Courses every 1–3 months if needed, followed by diethylcarbamazine

 < 30,000 mf/ml:

Ivermectin under hospitalization

Or albendazole followed by ivermectin

 > 30,000 mf/ml:

Albendazole, possibly apheresis

Adjunct therapy:

Possibly concomitant corticosteroids or antihistamines

[29], 2012

 Switzerland: endemic, and travellers and migrants

 < 100 mf/ml:

Diethylcarbamazine 9 mg/kg daily for 21 days (gradual dose increase from 1 mg/kg)

 > 100 mf/ml:

Albendazole 100 mg twice daily, three times a week

 < 1000 mf/ml:

Diethylcarbamazine 9 mg/kg for 21 days (gradual dose increase from 1 mg/kg), possibly after albendazole and/or ivermectin pre-therapy

 < 8000 mf/ml:

Ivermectin 150–200 μg/kg single dose, possibly after albendazole pre-therapy

 > 8000 mf/ml:

Albendazole 200 mg twice daily for 21 days, as pre-therapy

 > 8000 mf/ml:

Apheresis as pre-therapy

Adjunct therapy:

possibly concomitant corticosteroid or antihistamines

[25], 2012

 Endemic, and travellers and migrants

 < 1000 mf/ml:

Diethylcarbamazine 300–400 mg/d (gradual dose increase from 6.25 or 12.5mg/d) for 21 to 28 days

 < 8000 mf/ml:

Ivermectin 150–200 µg/kg single dose, then diethylcarbamazine

 > 8000 mf/ml:

Albendazole 200 mg twice daily for 21 days, or apheresis, then diethylcarbamazine

30,000–50,000 mf/ml:

Albendazole or apheresis, then diethylcarbamazine

Prophylaxis:

Diethylcarbamazine 300 mg weekly or 5 mg/kg for three consecutive days monthly

Adjunct therapy:

Possibly concomitant corticosteroids or antihistamines

[18], 2006

 Endemic

 < 50,000 mf/ml:

Ivermectin 200 µg/kg single dose, repeat every 6 months if needed

Diethylcarbamazine not further mentioned because of unavailability

[13], 2001

Textbooks

 Endemic

 < 8000 mf/ml:

Diethylcarbamazine 8 mg/kg three times daily for 21 days (gradual dose increase from 50 mg)

 < 20,000 mf/ml:

Ivermectin 150–200 μg/kg single dose, possibly with diethylcarbamazine or albendazole

Albendazole 200–400 mg orally twice daily for 21 days

Loa loa: latest advances in loiasis research (Akue)

[2], 2024

 Endemic, and travellers and migrants

 < 8000 mf/ml:

Diethylcarbamazine 5–10 mg/kg daily in divided doses for 14 to 28 days, repeat if needed ‡

Or ivermectin 200 mg/kg

 > 8000 mf/ml:

Apheresis, then diethylcarbamazine

Prophylaxis:

Diethylcarbamazine 300 mg weekly

Manson’s tropical diseases

[30], 2023

 Endemic, and travellers and migrants

Diethylcarbamazine 8–10 mg/kg orally for 21 days, repeat if needed

Or ivermectin or albendazole

 < 30,000 mf/ml:

Diethylcarbamazine 8–10 mg/kg orally for 21 days, repeat if needed

or ivermectin or albendazole

 > 30,000 mf/ml:

Apheresis and/or glucocorticoids (40–60 mg prednisone daily, possibly tapered rapidly), then diethylcarbamazine 8–10 mg/kg daily (gradual dose increase from 0.5 mg/kg daily) or albendazole

Prophylaxis:

diethylcarbamazine 300 mg weekly

Harrison’s principles of internal medicine

[22], 2022

 Endemic, and travellers and migrants

Diethylcarbamazine 400 mg/d for 21–28 days (gradual dose increase from 50 mg/d)

 < 2000 mf/ml:

diethylcarbamazine (gradual dose increase from 3–6 mg/d)

 < 8000 mf/ml:

Ivermectin 150 µg/kg single dose every 1–3 months, then diethylcarbamazine

 < 10,000 mf/ml:

See < 8000 mf/ml, inpatient care

 < 30,000 mf/ml:

albendazole 200mg twice daily for 21 days, then ivermectin or diethylcarbamazine

 > 30,000 mf/ml:

albendazole or apheresis, then ivermectin or diethylcarbamazine

Prophylaxis:

diethylcarbamazine 200 mg twice daily for three days monthly or 300 mg weekly

ePILLY

[24], 2022

 Endemic, and travellers and migrants

Diethylcarbamazine 9 mg/kg for 14 to 28 days (gradual dose increase from 6 mg/kg)

 < 1000 mf/ml:

Diethylcarbamazine for 14 to 28 days (inpatient, gradual dose increase from 1 mg/kg)

 < 8000 mf/ml:

Ivermectin 150–200 μg/kg single-dose

 > 8000 mf/ml:

Apheresis, then ivermectin or diethylcarbamazine‡

 > 8000 mf/ml, O. volvulus coinfection:

Albendazole 200 mg twice daily for 21 days or mebendazole, then ivermectin or diethylcarbamazine

Eye migration:

Surgical removal

Adjunct therapy:

Possibly concomitant salicylates, antihistamines or steroids (if microfilaremia > 25 mf/ml)

Meyer Tropenmedizin

[26], 2021

 Endemic

 < 2500 mf/ml:

Diethylcarbamazine for 21 days (gradual dose increase), repeat if needed

Or albendazole

 > 2500 mf/ml:

Apheresis or albendazole several weeks

Prophylaxis:

Diethylcarbamazine 300 mg weekly

Eye migration: surgical extraction possible

Adjunct therapy:

Possibly concomitant antihistamines or corticosteroids

Parasitic diseases (parasites without borders)

[35], 2019

 Switzerland: endemic, and travellers and migrants

 < 1000 mf/ml, adults:

Diethylcarbamazine 150 mg three times daily or 9 mg/kg daily for 21 days (gradual dose increase from 25 mg single dose)

 < 1000 mf/ml, children:

Diethylcarbamazine 3 mg/kg three times daily for 21 days (gradual dose increase from 0.5 mg/kg single dose)

 > 1000 mf/ml:

Albendazole 200 mg twice daily for 21 days, then diethylcarbamazine

 > 8000 mf/ml:

Possibly apheresis / plasmapheresis, then albendazole or diethylcarbamazine

Diethylcarbamazine failure:

Albendazole 200 to 400 mg twice daily for 21 to 28 days

Adjunct therapy:

Concomitant corticosteroids or antihistamines

Antiparasitic treatment recommendations

[15], 2018

 Germany: travellers and migrants

Diethylcarbamazine and ivermectin

Diethylcarbamazine and ivermectin

Albendazole, then diethylcarbamazine and ivermectin, inpatient, possibly concomitant antihistamines and corticosteroids

Eye migration: possibly surgical extraction

Medizinische Mikrobiologie und Infektiologie (Suerbaum)

[36], 2016

 USA: endemic, and travellers and migrants

Diethylcarbamazine 6–9 mg/kg daily for 21 days (gradual dose increase from 1 mg/kg daily)

Diethylcarbamazine 6–9 mg/kg daily for 21 days (gradual dose increase from 1 mg/kg daily), concomitant corticosteroids for 2–3 days

If O. volvulus coinfection:

Ivermectin 150 µg/kg, then diethylcarbamazine

Prophylaxis:

Diethylcarbamazine 300 mg once weekly

Oxford handbook of tropical medicine [27], 2014

 Endemic, and travellers and migrants

Irrespective of microfilaremia: diethylcarbamazine 6 mg daily for 14 to 21 days

Or ivermectin 150 µg/kg single-dose

Antibiotika-Therapie (Stille) [16], 2013

 Endemic, and travellers and migrants

 < 1000 mf/ml:

diethylcarbamazine 300–400 mg/d for 21 to 28 days (gradual dose increase from 6.25–12.5 mg), repetition every two or three weeks if needed

 < 8000 mf/ml:

Ivermectin 150–200 µg/kg single dose, then diethylcarbamazine

 > 8000 mf/ml:

Albendazole 200 mg twice daily for 21 days, then ivermectin, then diethylcarbamazine

Principles of medicine in Africa

[20], 2013

 France: endemic, and travellers and migrants

Diethylcarbamazine 400 mg/d for 21 days (gradual dose increase from 50 mg twice daily), repeat 10 d/month for 3–6 months, if needed

Diethylcarbamazine 400 mg/d for 21 days (gradual dose increase from 6.25 mg twice daily), repeat if needed

 < 30,000 mf/ml:

ivermectin or albendazole, then diethylcarbamazine

Prophylaxis:

Diethylcarbamazine 50 mg twice weekly or 100 mg weekly

Adjunct therapy:

Concomitant antihistamines and corticosteroids (15–20 mg prednisone/d),

Médecine tropicale

[19], 2012

 Germany: endemic, and travellers and migrants

 < 1000 mf/ml:

Diethylcarbamazine 9 mg/kg for 21 days (gradual dose increase from 1 mg/kg)

 < 8000 mf/ml:

ivermectin 150–200 µg/kg single dose

 < 8000 mf/ml:

albendazole 200 mg twice daily for 21 days or apheresis

Adjunct therapy:

Possibly concomitant antihistamines or corticosteroids

Tropenmedizin in Klinik und Praxis (Löscher and Burchard)

[28], 2010

 USA: endemic, and travellers and migrants

Diethylcarbamazine 6 mg/kg daily

For 12 days

Or ivermectin

Albendazole or ivermectin

Prophylaxis:

Diethylcarbamazine 300 mg once weekly

Eye migration:

Surgical removal, then systemic therapy

Stanford

[23], 2009