# A Triple Regimen as an Alternative Treatment for Lymphatic Filariasis in a Non-endemic Area in Indonesia: A Case Report

## TL;DR

A 19-year-old man in Indonesia with lymphatic filariasis showed improvement after a triple drug treatment when standard treatments failed.

## Contribution

A successful alternative triple regimen for treating lymphatic filariasis in a non-endemic area is reported.

## Key findings

- A triple regimen of albendazole, DEC, and ivermectin improved edema in a patient unresponsive to standard treatment.
- The treatment was well-tolerated with no adverse effects reported over 90 days.
- Persistent microfilaria detection suggests the need for further research on species-specific resistance.

## Abstract

Lymphatic filariasis is a neglected tropical disease. Although cases in Indonesia are not very common, the condition still poses a burden because of its chronic course and the disability it causes in daily life. Research on treatment is limited, especially for patients who do not respond to standard regimens in non-endemic areas. We report the case of a 19-year-old male with a four-year history of bilateral non-pitting edema of the lower limbs. He had no prior medical history and was diagnosed with filariasis of undetermined species because of limited laboratory capacity for species identification. Because diethylcarbamazine (DEC) was not available at the time, the patient was first treated with albendazole 400 mg twice daily for 14 days and a single dose of ivermectin 36 mg. Thirty days later, he returned with persistent edema, and blood smear examination still showed microfilaria. A second regimen consisting of single-dose albendazole 400 mg and DEC 600 mg daily for 12 days led to partial improvement in edema, although microfilariae were still detected. A third regimen was then administered: albendazole 400 mg twice daily for 21 days, DEC 600 mg daily for 12 days, and a single dose of ivermectin 48 mg, along with supportive lymphedema care. Over 90 days, his edema gradually improved, and no adverse effects were reported. A triple regimen of albendazole, DEC, and ivermectin was effective in a patient who failed the initial albendazole-ivermectin regimen. This approach may be considered in similar cases, but further studies are needed to explore species-specific resistance and guide treatment.