Deseril and diethylcarbamazine in the treatment of onchocerciasis.

SIR-We have previously experienced great difficulty in using diethylcarbamazine (dec) for the treatment of heavily infected patients in Cameroon (FUGLSANG & ANDERSON, 1974; ANDERSON et al., 1976). SALAZARMALLEN (personal communication) believes that an injection of Deseril (Sandoz) alleviates the initial adverse effects of dec in the skin and conjunctiva, and thus makes the use of this drug more acceptable in the treatment of onchocerciasis in Mexico. We have therefore carried out a small study to assess the possible beneficial effects of Deseril tablets in the treatment of heavily infected patients in Cameroon. Out-patient treatment was commenced on nine patients with ocular onchocerciasis as follows : dec 25 mg morning and evening on day one, 50 mg morning and evening on day two, 100 mg morning and evening on day three, 150 mg morning and evening on day four, and 200 mg morning and evening on subsequent days. With each dec dose the patients received a 1.4 mg tablet of Deseril, but steroid cover was not given. Two patients refused to continue the treatment after the second dose of dec, and the remaining seven were all so prostrated after the third or fourth administration, that they did not attend for the next dose. At this stage one patient, a male of 37, was near collapse, with hypotension, tachycardia, and fast respiratory rate. Although the seven patients returned for the later dosages, it was not considered safe to deprive them of additional corticosteroid cover. This small study suggested that Deseril alone failed to alleviate the most s&ious reactions. In a further study, 13 out-patients were given dec and Deseril as above, together with the corticosteroid Betnelan. As judged by the attendance rate during the first critical days of treatment, this group did rather worse than a group of 14 patients treated with dec and Betnelan alone, since five of the 13 did not attend for the fourth or fifth dose as compared with three of the 14 in the second group. The Mazzotti reaction seemed to be diminished equally by both Betnelan and Deseril, and no case, whether on Deseril or Betnelan as the only alleviator, showed excessive reactions to treatment in the eye. LAGRAULET et al. (1964) treated 60 patients with dec and Deseril tablets in Upper Volta, and they compared the adverse effects with those seen in a similar control group treated with dec alone. They concluded that Deseril might have a slight action on the urticarial type of reaction provoked by dec, but that it did not diminish the duration of this reaction or of the pruritus. From the above studies we conclude that Deseril tablets do not alleviate the side effects of dec in Africa. We are, etc., HARALD FUGLSANG JOHN ANDERSON MRC/ WHO grantholders, O.N.A.R.E.S.T., Box 55, Kumba, Cameroon