Treatment of loiasis in adult and pediatric patients

	Preferred treatment approach	Alternative regimens	Comments
L. loa monoinfection
L. loa microfilariae <2500/mL	DEC with a graded dosing schedule as follows: Day 1: 50 mg (1 mg/kg) Day 2: 50 mg (1 mg/kg) three times a day Day 3: 100 mg (1 to 2 mg/kg) three times a day Day 4 to 21: 9 mg/kg/day in three divided doses	Albendazole (200 mg twice daily for 21 days)^*	DEC can provoke serious adverse effects, including shock and/or fatal encephalopathy, in patients with high microfilarial loads. Avoid DEC in pregnancy.
L. loa microfilariae 2500 to 20,000/mL	Ivermectin (150 mcg/kg single dose) for reduction of microfilaremia below 2500/mL^¶ followed by DEC for definitive treatment, with a graded dosing schedule as follows: Day 1: 50 mg (1 mg/kg) Day 2: 50 mg (1 mg/kg) three times a day Day 3: 100 mg (1 to 2 mg/kg) three times a day Day 4 to 21: 9 mg/kg/day in three divided doses	Albendazole (200 mg twice daily for 21 days)^*Δ	Ivermectin can provoke serious adverse effects, including fatal encephalopathy, in patients with high microfilarial loads – but has a higher safety threshold than DEC.
L. loa microfilariae >20,000/mL	Albendazole (200 mg twice daily for 21 days^Δ) for reduction of microfilaremia below 2500/mL^◊ followed by DEC for definitive treatment, with a graded dosing schedule as follows: Day 1: 50 mg (1 mg/kg) Day 2: 50 mg (1 mg/kg) three times a day Day 3: 100 mg (1 to 2 mg/kg) three times a day Day 4 to 21: 9 mg/kg/day in three divided doses		WHO allows albendazole use in 2^nd and 3^rd trimester pregnancy^[1].
L. loa coinfection with onchocerciasis^§
L. loa microfilariae <20,000/mL	Ivermectin (150 mcg/kg single dose) for onchocerciasis microfilarial reduction followed by Albendazole (200 mg twice daily for 21 days^Δ) for loiasis	Albendazole (200 mg twice daily for 21 days^Δ) for loiasis, with documentation of reduction in L. loa microfilarial levels followed by Ivermectin (150 mcg/kg single dose) for onchocerciasis Doxycycline (200 mg daily for 6 weeks) for onchocerciasis followed by Albendazole (200 mg twice daily for 21 days^Δ) for loiasis	DEC is contraindicated in onchocerciasis. The risk of ivermectin administration should be weighed against the severity of clinical manifestations in deciding whether to treat with ivermectin at presentation. L. loa microfilaremia should be reassessed at 6 and 12 months to determine the risk of subsequent administration of ivermectin. Use of doxycycline is a regimen of last resort; doxycycline does not take effect quickly and acts primarily against adult worms (which are not responsible for blindness or itching).
L. loa microfilariae ≥20,000/mL	Ivermectin (150 mcg/kg single dose) with close observation in an inpatient setting for onchocerciasis microfilarial reduction followed by Albendazole (200 mg twice daily for 21 days^Δ) for loiasis
L. loa coinfection with lymphatic filariasis	Same as for L. loa monoinfection
L. loa coinfection with onchocerciasis and lymphatic filariasis	Same as for L. loa coinfection with onchocerciasis

This table is intended for use in conjunction with UpToDate content on Loa loa infection. Treatment of loiasis is complex and best undertaken in consultation with an experienced clinician. All doses are for oral administration in patients with normal kidney and liver function. Dose reduction of DEC may be warranted in patients with reduced kidney function.

DEC doses are expressed as citrate salt. Some products express dosing according to DEC base (approximate conversion is 2:1); review product-specific information carefully. DEC is not commercially available in the United States; it is available from the CDC drug service at +1 (404) 639-2888 (email [email protected]).

CDC: Centers for Disease Control and Prevention; DEC: diethylcarbamazine; L. loa: Loa loa; WHO: World Health Organization.

* Albendazole for treatment of loiasis has only been demonstrated to be curative in loiasis that is refractory to diethylcarbamazine.

¶ Microfilarial counts should be checked 2 to 4 weeks after ivermectin to ensure that the microfilarial load is <2500/mL prior to diethylcarbamazine.

Δ Reduction of microfilaremia with albendazole can take up to 6 months. In children <6 years, a dose reduction of albendazole may be needed; however, specific recommendations are not available^[1].

◊ If albendazole reduces microfilaremia to <20,000/mL but >2500/mL, ivermectin should be administered for further reduction of microfilaremia below 2500/mL prior to administration of diethylcarbamazine.

§ Treatment of patients with onchocerciasis-loiasis coinfection requires careful attention; refer to UpToDate text for further discussion of treatment approach.

Reference:

Clinical treatment of loiasis. Centers for Disease Control and Prevention. https://www.cdc.gov/filarial-worms/hcp/clinical-care/loiasis.html (Accessed on April 23, 2025).

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Treatment of loiasis in adult and pediatric patients