Chagas disease medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Benznidazole and nifurtimox are the only antimicrobial therapies with proven efficacy against T. cruzi infection. Neither drug is FDA-approved, but can be obtained under investigational protocol. Either benznidazole or nifurtimox may be used to manage congenital infection, acute infection, and chronic infection (only among young patients < 50-55 years) including those with early cardiomyopathy.
Medical Therapy
- Benznidazole and nifurtimox are the only 2 antimicrobial agents that have demonstrated to be effective against T. cruzi infection.
- Neither benznidazole nor nifurtimox is FDA-approved in the treatment of T. cruzi, but are often used as investigational protocols.
Acute Chagas Disease
- Both benznizadole and nifurtimox are effective against acute T. cruzi infections with a cure rate that ranges from 80% to 90%.[1]
Chronic Chagas Disease
- While it was thought that chronic Chagas disease cannot be managed by pharmacotherapy, new evidence from randomized and non-randomized trials demonstrated that young patients (age < 50-55 years of age) with chronic Chagas disease, including those with early cardiomyopathy, may be managed using long-term antitrypanosomal antimicrobial therapy.[2][3]
- Seroconversion (seropositivity to seronegativity) may only occur several years following the beginning of antimicrobial therapy.[1]
Congenital Chagas Disease
- Similar to acute Chagas disease, both benznizadole and nifurtimox are effective against acute T. cruzi infections. When managed early, the cure rate of congenital Chagas disease ranges from 80% to 90%.[1]
Antimicrobial Regimen
- Chagas disease[4]
- 1. Preferred regimen(1):
- Patients of age < 12 years- Benznidazole 5-7.5 mg/kg/ day PO bid for 60 days
- Patients of age 12 years or older- Benznidazole 5-7 mg/kg/day PO bid for 60 days
- 2. Preferred regimen(2):
- Patients of age ≤ 10 years- Nifurtimox 15-20 mg/kg/day PO tid/ qid for 90 days
- Patients of age 11-16 years- Nifurtimox 12.5-15 mg/kg/day PO tid/ qid for 90 days
- Patients of age 17 years or older- Nifurtimox 8-10 mg/kg/day PO tid/ qid for 90 days
- Note: In the United States, Nifurtimox and Benznidazole are not FDA approved and are available only from CDC under investigational protocols.
References
- ↑ 1.0 1.1 1.2 Bern C (2015). "Chagas' Disease". N Engl J Med. 373 (5): 456–66. doi:10.1056/NEJMra1410150. PMID 26222561.
- ↑ de Andrade AL, Zicker F, de Oliveira RM, Almeida Silva S, Luquetti A, Travassos LR; et al. (1996). "Randomised trial of efficacy of benznidazole in treatment of early Trypanosoma cruzi infection". Lancet. 348 (9039): 1407–13. PMID 8937280.
- ↑ Sosa Estani S, Segura EL, Ruiz AM, Velazquez E, Porcel BM, Yampotis C (1998). "Efficacy of chemotherapy with benznidazole in children in the indeterminate phase of Chagas' disease". Am J Trop Med Hyg. 59 (4): 526–9. PMID 9790423.
- ↑ "Parasites - American Trypanosomiasis (also known as Chagas Disease)".