African trypanosomiasis medical therapy: Difference between revisions
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All patients should be followed up for two years with lumbar punctures every six months to look for relapse. | All patients should be followed up for two years with lumbar punctures every six months to look for relapse. | ||
==References== | ==References== | ||
Revision as of 14:10, 30 August 2012
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African trypanosomiasis Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Pilar Almonacid
Overview
Medical Therapy
- Medical treatment of East African trypanosomiasis should begin as soon as possible and is based on the infected person’s symptoms and laboratory results. Medication for the treatment of East African trypanosomiasis is available through the CDC. Hospitalization for treatment is necessary. Periodic follow-up exams that include a spinal tap are required for 2 years. If a person fails to receive medical treatment for East African trypanosomiasis, death will occur within several weeks to months.
- Medication for the treatment of West African trypanosomiasis is available. Hospitalized treatment of West African trypanosomiasis should begin as soon as possible and is based on the infected person’s symptoms and laboratory results. Hospitalization for treatment is necessary. Periodic follow-up exams that include a spinal tap are required for 2 years. West African trypanosomiasis is fatal if it is not treated.
Pharmacotherapy
Pentamidine isethionate and suramin (under an investigational New Drug Protocol from the CDC Drug Service) are the drugs of choice to treat the hemolymphatic stage of West and East African Trypanosomiasis, respectively. Melarsoprol is the drug of choice for late disease with central nervous system involvement (infections by T.b. gambiense or T. b. rhodiense). The current standard treatment for first stage disease is:
- Intravenous pentamidine (for T.b. gambiense); or
- Intravenous suramin (for T.b. rhodesiense)
The current standard treatment for second stage (late stage) disease is:
- Intravenous melarsoprol 2.2 mg/kg daily for 10 consecutive days.[2]
Alternative first line therapies include:
- Intravenous melarsoprol 0.6 mg/kg on day 1, 1.2 mg/kg iv melarsoprol on day 2, and 1.2 mg/kg/day iv melarsoprol combined with oral 7.5 mg/kg nifurtimox twice a day on days 3 to 10;[3] or
- Intravenous eflornithine 50 mg/kd every six hours for 14 days.[4]
In areas with melarsoprol resistance or in patients who have relapsed after melarsoprol monotherapy, the treatment should be:
- melarsoprol and nifurtimox, or
- eflornithine
The following traditional regimens should no longer be used:
- (old "standard" 26-day melarsoprol therapy) Intravenous melarsoprol therapy (3 series of 3.6 mg/kg/day intravenously for 3 days, with 7-day breaks between the series) (this regimen is less convenient and patients are less likely to complete therapy)[5];
- (incremental melarsoprol therapy) 10-day incremental-dose melarsoprol therapy (0.6 mg/kg iv on day 1, 1.2 mg/kg iv on day 2, and 1.8 mg/kg iv on days 3–10) (previously thought to reduce the risk of treatment-induced encephalopathy, but now known to be associated with an increased risk of relapse and a higher incidence of encephalopathy)[3][5];
According to a treatment study of Trypanosoma gambiense caused human African trypanosomiasis, use of eflornithine (DMFO) resulted in fewer adverse events than treatment with melaroprol. [6]
All patients should be followed up for two years with lumbar punctures every six months to look for relapse.
References
- ↑ http://www.cdc.gov/ncidod/dpd/parasites/trypanosomiasis/factsht_ea_trypanosomiasis.htm#what http://www.cdc.gov/ncidod/dpd/parasites/trypanosomiasis/factsht_wa_trypanosomiasis.htm#Top http://www.dpd.cdc.gov/dpdx/HTML/TrypanosomiasisAfrican.htm
- ↑ "Efficacy of new, concise schedule for melarsoprol in treatment of sleeping sickness caused by Trypanosoma brucei gambiense: a randomised trial". Lancet. 355 (9213): 1419&ndash, 25. 2000. PMID 10791526. Text " Burri C, Nkunku S, Merolle A, et al. " ignored (help)
- ↑ 3.0 3.1 Bisser S, N'Siesi F-X, Lejon V; et al. (2007). J Infect Dis. 195: 322&ndash, 29 http://www.journals.uchicago.edu/JID/journal/issues/v195n3/36827/36827.html. Missing or empty
|title=(help) - ↑ van Nieuwenhove S, Schechter PJ, Declercq J; et al. (1985). "Treatment of gambiense sleeping sickness in the Sudan with oral DFMO (DL-alfa-difluoromethyl ornithine) an inhibitor of ornithine decarboxylase: first field trial". Trans R Soc Trop Med Hyg. 79 (5): 692&ndash, 8.
- ↑ 5.0 5.1 Pepin J, Mpia B (2006). "Randomized controlled trial of three regimens of melarsoprol in the treatment of Trypanosoma brucei gambiense trypanosomiasis". Trans R Soc Trop Med Hyg. 100: 437&ndash, 41. PMID 16483622.
- ↑ Chappuis F, Udayraj N, Stietenroth K, Meussen A, Bovier PA (2005). "Eflornithine is safer than melarsoprol for the treatment of second-stage Trypanosoma brucei gambiense human African trypanosomiasis". Clin. Infect. Dis. 41 (5): 748–51. doi:10.1086/432576. PMID 16080099.