A randomized clinical trial to compare the efficacy of three treatment regimens along with footcare in the morbidity management of filarial lymphoedema
Identifieur interne : 008638 ( Main/Exploration ); précédent : 008637; suivant : 008639A randomized clinical trial to compare the efficacy of three treatment regimens along with footcare in the morbidity management of filarial lymphoedema
Auteurs : A. S. Kerketta [Inde] ; B. V. Babu [Inde] ; K. Rath [Inde] ; P. K. Jangid [Inde] ; A. N. Nayak [Inde] ; S. K. Kar [Inde]Source :
- TM & IH. Tropical medicine & international health [ 1360-2276 ] ; 2005.
Descripteurs français
- KwdFr :
- Administration par voie orale, Administration par voie topique, Adolescent, Adulte, Adulte d'âge moyen, Anti-infectieux (administration et posologie), Anti-infectieux locaux (administration et posologie), Antibactériens (administration et posologie), Calendrier d'administration des médicaments, Diéthylcarbamazine (administration et posologie), Filaricides (administration et posologie), Filariose lymphatique (), Filariose lymphatique (traitement médicamenteux), Humains, Jambe (anatomopathologie), Lymphangite (), Lymphangite (parasitologie), Lymphangite (traitement médicamenteux), Pied, Povidone iodée (administration et posologie), Pénicillines (administration et posologie), Résultat thérapeutique, Santé en zone rurale, Sujet âgé.
- MESH :
- administration et posologie : Anti-infectieux, Anti-infectieux locaux, Antibactériens, Diéthylcarbamazine, Filaricides, Povidone iodée, Pénicillines.
- anatomopathologie : Jambe.
- parasitologie : Lymphangite.
- traitement médicamenteux : Filariose lymphatique, Lymphangite.
- Pascal (Inist)
- Administration par voie orale, Administration par voie topique, Adolescent, Adulte, Adulte d'âge moyen, Calendrier d'administration des médicaments, Filariose lymphatique, Humains, Lymphangite, Lymphoedème, Filariose lymphatique, Diéthylcarbamazine, Essai clinique, Etude comparative, Pied, Résultat thérapeutique, Santé en zone rurale, Sujet âgé, Traitement, Epidémiologie, Morbidité, Orissa, Médecine tropicale, Antiparasitaire, Anthelminthique.
English descriptors
- KwdEn :
- Administration, Oral, Administration, Topical, Adolescent, Adult, Aged, Anthelmintic, Anti-Bacterial Agents (administration & dosage), Anti-Infective Agents (administration & dosage), Anti-Infective Agents, Local (administration & dosage), Clinical trial, Comparative study, Diethylcarbamazine, Diethylcarbamazine (administration & dosage), Drug Administration Schedule, Elephantiasis, Filarial (drug therapy), Elephantiasis, Filarial (therapy), Epidemiology, Filaricides (administration & dosage), Foot, Humans, Leg (pathology), Lymphangitis (drug therapy), Lymphangitis (parasitology), Lymphangitis (prevention & control), Lymphatic filariasis, Lymphedema, Middle Aged, Morbidity, Orissa, Parasiticide, Penicillins (administration & dosage), Povidone-Iodine (administration & dosage), Rural Health, Treatment, Treatment Outcome, Tropical medicine.
- MESH :
- chemical , administration & dosage : Anti-Bacterial Agents, Anti-Infective Agents, Anti-Infective Agents, Local, Diethylcarbamazine, Filaricides, Penicillins, Povidone-Iodine.
- drug therapy : Elephantiasis, Filarial, Lymphangitis.
- parasitology : Lymphangitis.
- pathology : Leg.
- prevention & control : Lymphangitis.
- therapy : Elephantiasis, Filarial.
- Administration, Oral, Administration, Topical, Adolescent, Adult, Aged, Drug Administration Schedule, Foot, Humans, Middle Aged, Rural Health, Treatment Outcome.
Abstract
The progression of lymphoedema to elephantiasis associated with increased incidence of episodic adeno-lymphangitis (ADL) is of great concern, as it causes physical suffering, permanent disability and economic loss to lymphatic filariasis patients. This randomized clinical trial aimed to assess the efficacy in terms of reduction of oedema and ADL frequency of three treatment regimens among lymphoedema patients from Orissa, India. The regimens were: (I) oral penicillin - one tablet of 800 000 U penicillin G potassium twice daily for 12 days-repeated every 3 months for 1 year; (II) diethylcarbamazine - 6 mg/kg bodyweight for 12 days-repeated every 3 months for 1 year; and (III) topical antiseptic, i.e. betadine ointment. Foot care was part of all regimens. All three drug regimens are efficacious in reducing oedema and frequency of ADL episodes. Although the efficacy was slightly higher in regimen I, the difference was not significant. About half of all patients had reduced oedema after the 90 days of treatment, with oedema reduction of 75-100% in 20%. A major proportion of the remaining patients had oedema reduced by less than 25%. The proportion of people whose oedema reduced was slightly but not significantly lower in regimen II. ANOVA revealed that lymphoedema reduction varied according to grade; being greatest at grade 1 lymphoedema, followed by grade 2. All three regimens significantly reduced ADL frequency after 1 year of treatment. This may be because of foot care as well as use of antibiotics. The estimated costs of treatment per patient for a period of 3 months are US$2.4, 1.5 and 4.0 respectively for regimen I, II and III. Thus affordable treatments with simple antibiotics and foot care can give substantial relief to the patients and reverse early lymphoedema.
Affiliations:
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S." last="Kerketta">A. S. Kerketta</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Clinical and Epidemiology Division, Regional Medical Research Centre, Indian Council of Medical Research</s1><s2>Bhubaneswar</s2><s3>IND</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Inde</country><wicri:noRegion>Bhubaneswar</wicri:noRegion></affiliation></author><author><name sortKey="Babu, B V" sort="Babu, B V" uniqKey="Babu B" first="B. V." last="Babu">B. V. Babu</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Clinical and Epidemiology Division, Regional Medical Research Centre, Indian Council of Medical Research</s1><s2>Bhubaneswar</s2><s3>IND</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Inde</country><wicri:noRegion>Bhubaneswar</wicri:noRegion></affiliation></author><author><name sortKey="Rath, K" sort="Rath, K" uniqKey="Rath K" first="K." last="Rath">K. Rath</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Clinical and Epidemiology Division, Regional Medical Research Centre, Indian Council of Medical Research</s1><s2>Bhubaneswar</s2><s3>IND</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Inde</country><wicri:noRegion>Bhubaneswar</wicri:noRegion></affiliation></author><author><name sortKey="Jangid, P K" sort="Jangid, P K" uniqKey="Jangid P" first="P. K." last="Jangid">P. K. Jangid</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Clinical and Epidemiology Division, Regional Medical Research Centre, Indian Council of Medical Research</s1><s2>Bhubaneswar</s2><s3>IND</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Inde</country><wicri:noRegion>Bhubaneswar</wicri:noRegion></affiliation></author><author><name sortKey="Nayak, A N" sort="Nayak, A N" uniqKey="Nayak A" first="A. N." last="Nayak">A. N. Nayak</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Clinical and Epidemiology Division, Regional Medical Research Centre, Indian Council of Medical Research</s1><s2>Bhubaneswar</s2><s3>IND</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Inde</country><wicri:noRegion>Bhubaneswar</wicri:noRegion></affiliation></author><author><name sortKey="Kar, S K" sort="Kar, S K" uniqKey="Kar S" first="S. K." last="Kar">S. K. Kar</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Clinical and Epidemiology Division, Regional Medical Research Centre, Indian Council of Medical Research</s1><s2>Bhubaneswar</s2><s3>IND</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Inde</country><wicri:noRegion>Bhubaneswar</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">TM & IH. Tropical medicine & international health</title><title level="j" type="abbreviated">TM IH, Trop. med. int. health</title><idno type="ISSN">1360-2276</idno><imprint><date when="2005">2005</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">TM & IH. Tropical medicine & international health</title><title level="j" type="abbreviated">TM IH, Trop. med. int. health</title><idno type="ISSN">1360-2276</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Administration, Oral</term><term>Administration, Topical</term><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Anthelmintic</term><term>Anti-Bacterial Agents (administration & dosage)</term><term>Anti-Infective Agents (administration & dosage)</term><term>Anti-Infective Agents, Local (administration & dosage)</term><term>Clinical trial</term><term>Comparative study</term><term>Diethylcarbamazine</term><term>Diethylcarbamazine (administration & dosage)</term><term>Drug Administration Schedule</term><term>Elephantiasis, Filarial (drug therapy)</term><term>Elephantiasis, Filarial (therapy)</term><term>Epidemiology</term><term>Filaricides (administration & dosage)</term><term>Foot</term><term>Humans</term><term>Leg (pathology)</term><term>Lymphangitis (drug therapy)</term><term>Lymphangitis (parasitology)</term><term>Lymphangitis (prevention & control)</term><term>Lymphatic filariasis</term><term>Lymphedema</term><term>Middle Aged</term><term>Morbidity</term><term>Orissa</term><term>Parasiticide</term><term>Penicillins (administration & dosage)</term><term>Povidone-Iodine (administration & dosage)</term><term>Rural Health</term><term>Treatment</term><term>Treatment Outcome</term><term>Tropical medicine</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Administration par voie orale</term><term>Administration par voie topique</term><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Anti-infectieux (administration et posologie)</term><term>Anti-infectieux locaux (administration et posologie)</term><term>Antibactériens (administration et posologie)</term><term>Calendrier d'administration des médicaments</term><term>Diéthylcarbamazine (administration et posologie)</term><term>Filaricides (administration et posologie)</term><term>Filariose lymphatique ()</term><term>Filariose lymphatique (traitement médicamenteux)</term><term>Humains</term><term>Jambe (anatomopathologie)</term><term>Lymphangite ()</term><term>Lymphangite (parasitologie)</term><term>Lymphangite (traitement médicamenteux)</term><term>Pied</term><term>Povidone iodée (administration et posologie)</term><term>Pénicillines (administration et posologie)</term><term>Résultat thérapeutique</term><term>Santé en zone rurale</term><term>Sujet âgé</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Anti-Bacterial Agents</term><term>Anti-Infective Agents</term><term>Anti-Infective Agents, Local</term><term>Diethylcarbamazine</term><term>Filaricides</term><term>Penicillins</term><term>Povidone-Iodine</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Anti-infectieux</term><term>Anti-infectieux locaux</term><term>Antibactériens</term><term>Diéthylcarbamazine</term><term>Filaricides</term><term>Povidone iodée</term><term>Pénicillines</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Jambe</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Elephantiasis, Filarial</term><term>Lymphangitis</term></keywords><keywords scheme="MESH" qualifier="parasitologie" xml:lang="fr"><term>Lymphangite</term></keywords><keywords scheme="MESH" qualifier="parasitology" xml:lang="en"><term>Lymphangitis</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Leg</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Lymphangitis</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Elephantiasis, Filarial</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Filariose lymphatique</term><term>Lymphangite</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Administration, Oral</term><term>Administration, Topical</term><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Drug Administration Schedule</term><term>Foot</term><term>Humans</term><term>Middle Aged</term><term>Rural Health</term><term>Treatment Outcome</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Administration par voie orale</term><term>Administration par voie topique</term><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Calendrier d'administration des médicaments</term><term>Filariose lymphatique</term><term>Humains</term><term>Lymphangite</term><term>Lymphoedème</term><term>Filariose lymphatique</term><term>Diéthylcarbamazine</term><term>Essai clinique</term><term>Etude comparative</term><term>Pied</term><term>Résultat thérapeutique</term><term>Santé en zone rurale</term><term>Sujet âgé</term><term>Traitement</term><term>Epidémiologie</term><term>Morbidité</term><term>Orissa</term><term>Médecine tropicale</term><term>Antiparasitaire</term><term>Anthelminthique</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The progression of lymphoedema to elephantiasis associated with increased incidence of episodic adeno-lymphangitis (ADL) is of great concern, as it causes physical suffering, permanent disability and economic loss to lymphatic filariasis patients. This randomized clinical trial aimed to assess the efficacy in terms of reduction of oedema and ADL frequency of three treatment regimens among lymphoedema patients from Orissa, India. The regimens were: (I) oral penicillin - one tablet of 800 000 U penicillin G potassium twice daily for 12 days-repeated every 3 months for 1 year; (II) diethylcarbamazine - 6 mg/kg bodyweight for 12 days-repeated every 3 months for 1 year; and (III) topical antiseptic, i.e. betadine ointment. Foot care was part of all regimens. All three drug regimens are efficacious in reducing oedema and frequency of ADL episodes. Although the efficacy was slightly higher in regimen I, the difference was not significant. About half of all patients had reduced oedema after the 90 days of treatment, with oedema reduction of 75-100% in 20%. A major proportion of the remaining patients had oedema reduced by less than 25%. The proportion of people whose oedema reduced was slightly but not significantly lower in regimen II. ANOVA revealed that lymphoedema reduction varied according to grade; being greatest at grade 1 lymphoedema, followed by grade 2. All three regimens significantly reduced ADL frequency after 1 year of treatment. This may be because of foot care as well as use of antibiotics. The estimated costs of treatment per patient for a period of 3 months are US$2.4, 1.5 and 4.0 respectively for regimen I, II and III. Thus affordable treatments with simple antibiotics and foot care can give substantial relief to the patients and reverse early lymphoedema.</div></front></TEI><affiliations><list><country><li>Inde</li></country></list><tree><country name="Inde"><noRegion><name sortKey="Kerketta, A S" sort="Kerketta, A S" uniqKey="Kerketta A" first="A. S." last="Kerketta">A. S. Kerketta</name></noRegion><name sortKey="Babu, B V" sort="Babu, B V" uniqKey="Babu B" first="B. V." last="Babu">B. V. Babu</name><name sortKey="Jangid, P K" sort="Jangid, P K" uniqKey="Jangid P" first="P. K." last="Jangid">P. K. Jangid</name><name sortKey="Kar, S K" sort="Kar, S K" uniqKey="Kar S" first="S. K." last="Kar">S. K. Kar</name><name sortKey="Nayak, A N" sort="Nayak, A N" uniqKey="Nayak A" first="A. N." last="Nayak">A. N. Nayak</name><name sortKey="Rath, K" sort="Rath, K" uniqKey="Rath K" first="K." last="Rath">K. Rath</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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