In a single-blind comparative study of diethylcarbamazine (DEC) and metrifonate against onchocerciasis, 20 patient received a total dose of 6.6 g DEC over a two-week period and 20 patients each received one dose of metrifonate 10 mg/kg body weight at ten-day intervals, three times. Both the efficacy and the severity of reaction to treatment were measured. DEC proved the more effective, destroying 98.9% of the microfilarial load while metrifonate destroyed only 75.4% (assessed one week after completion of treatment). The reaction to treatment was much more severe in patients treated with DEC. The persistence of significant postural cardiovascular effects for two weeks after the completion of DEC needs to be considered in mass therapy. The pattern of re-emergence of skin microfilariae indicated no difference between the two drugs over a six-month period. It is concluded that DEC is more effective than metrifonate and remains the 'reference' microfilaricide although its effects are more severe than those of metrifonate.