treatments, with the counts remaining to pretreatment values. This is consistent with the findings of previous studies which have suggested ivermectin, when used alone, has little or no effect on M. perstans microfilaraemias. A reduction of microfilariae in patients has been noted, but it takes a long time to achieve (over 3 yr of administration of ivermectin), and is thus not useful in the short term for symptomatic patients. Albendazole Single doses of albendazole alone have been consistently reported to have little or no effect on M. perstans microfilaremias in 6 and 12 m after treatment, with counts of microfilaremias remaining close to pretreatment values. More recent studies have shown the drug to be more effective at high doses for prolonged periods of time. No side effects have been reported from recent studies. Mebendazole Mebendazole, another possible treatment for M. perstans filariasis, has been shown to be effective in significantly reducing microfilariae levels. It has been more effective than both ivermectin and DEC—with a greater number of responders, a more significant reduction in microfilariae levels, and the ability to eliminate the infection more efficiently. Thiabendazole Thiabendazole has been shown to result in a small but significant decrease in microfilariae and in eosinophil count, and symptoms as treatment for symptomatic M. perstans infection. These markers were reduced even further following the administration of the second dose, showing that thiabendazole may be effective in M. perstans infection. In a recent comparative study, thiabendazole at a higher activity than single drug treatments such as ivermectin, DEC, and mebendazole, but lower activity than the combined regimen of mebendazole and DEC. However, more research may be needed into confirm the correct dosage and true effectiveness of thiabendazole in combating M. perstans infection. Praziquantel Praziquantel is effective against various helminthic and protozoan infections. The few studies about the use of praziquantel against M. perstans infection do not support its use for treatment of mansonelliasis. Doxycycline Doxycycline has been shown to decrease the development, embryogenesis, and fertility of worms in species that harbor the intracellular endosymbiont Wolbachia. Wolbachiae are bacterial endosymbionts of insects and many filarial nematodes, such as Onchocerca volvulus, Wuchereria bancrofti, and Brugia malayi. The dependence of these parasites on their endosymbionts has led to the use of antibiotics directed against the wolbachiae, antibiotics that have been demonstrated to have a profound salutary effect on filarial infections. In 2009, Coulibaly et al. conducted an open-label