Trypanosomiasis Medication

Updated: Mar 16, 2016
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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Medication

Medication Summary

Current consensus recommendations strongly recommend treatment for patients diagnosed with acute, congenital, or with reactivation of infection. Children aged 18 years or younger with chronic infection should also be treated. Most of these consensus recommendations suggest offering treatment to adults with chronic infection, as well. [56]

The acute phase of Chagas disease is treated with nifurtimox or benznidazole. [56] Both agents reduce the duration and severity of acute and congenital Chagas disease. Treatment is also indicated in a patient with HIV who has reactivation trypanosomiasis. Both agents are available in the United States from the drug service of the CDC at the Parasite Drug Service, which can be reached at (770) 488-7775 during business hours and at (770) 488-7100 on evenings, weekends, and holidays. Questions regarding treatment of Chagas disease should be directed to CDC Parasitic Diseases Inquiries (404-718-4745; email chagas@cdc.gov) M-F 8:00am-4pm EST. For emergencies (for example, acute Chagas disease with severe manifestations, Chagas disease in a newborn, or Chagas disease in an immunocompromised person) outside of regular business hours, call the CDC Emergency Operations Center (770-488-7100) and ask to talk to the person on-call for Parasitic Diseases.

Nifurtimox has been reported to be 75-90% effective. In some areas, such as Brazil, it is not as effective. Benznidazole has similar efficacy and may be better tolerated than nifurtimox. PCR can be used to monitor treatment response. [57]  

A long-term follow-up study of patients with chronic disease treated with benznidazole revealed a significant decrease in the electrocardiographic changes, clinical deterioration, and rate of seropositivity. Allopurinol has been shown to be as effective as nifurtimox and benznidazole in suppressing parasitemia with fewer adverse effects. [58] However, the open and nonrandomized study structure and the lack of well-defined criteria for cure make interpretation of these findings difficult. In addition, allopurinol has recently been ineffective in eradicating T cruzi in patients from Brazil. In Chile, the use of itraconazole has been shown to decrease electrocardiographic abnormalities in some patients with chronic Chagas disease. [59]

Nifurtimox and recombinant interferon alfa successfully treated Chagas disease in a child who acquired the disease through transfusion and in a laboratory worker who accidentally was infected. Interferon alfa may improve the activation of macrophages that kill the organism.

Thioridazine is a phenothiazine with high antitrypanothionine reductase activity that has been shown to be effective in preventing chagasic myocardiopathy in mice when used in the acute phase of infection. [60]

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Anthelmintics

Class Summary

These are used to treat acute and congenital Chagas disease. Parasite biochemical pathways are different from the human host, thus toxicity is directed to the parasite, egg, or larvae. Mechanism of action varies within the drug class. Antiparasitic actions may include the following:

- Inhibition of microtubules causes irreversible block of glucose uptake

- Tubulin polymerization inhibition

- Depolarizing neuromuscular blockade

- Cholinesterase inhibition

- Increased cell membrane permeability, resulting in intracellular calcium loss

- Vacuolization of the schistosome tegument

- Increased cell membrane permeability to chloride ions via chloride channels alteration

Nifurtimox (Lampit)

Used to treat acute and congenital Chagas disease. It decreases the period of acute disease and decreases the mortality rate from myocarditis and meningoencephalitis. It interferes with the parasite's carbohydrate metabolism by inhibiting pyruvic acid synthesis. Available in the US via a compassionate IND from the CDC.

Benznidazole (Rochagan)

Imidazole that inhibits nucleic acid synthesis. Used for acute and congenital Chagas disease. More trypanocidal than nifurtimox. Not available in the US.

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