African trypanosomiasis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Pilar Almonacid

Overview

Medical treatment of African trypanosomiasis should begin as soon as possible and is based on the infected person’s symptoms and laboratory results. Pentamidine isethionate and suramin (under an investigational New Drug Protocol from the CDC Drug Service) are the drugs of choice to treat the hemolymphatic stages 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). Hospitalization for treatment is necessary. Periodic follow-up exams including a spinal tap are required for 2 years. If a person fails to receive medical treatment for African trypanosomiasis, death will occur within several weeks to months.[1][2][3][4]

Medical Therapy

Antimicrobial Regimen

  • Sleeping sickness[5]
  • 1. East African trypanosomiasis
  • 1.1 T. b. rhodesiense, hemolymphatic stage
  • 1.1.1 Adult
  • Preferred regimen: Suramin 1 gm IV on days 1, 3, 5, 14, and 21
  • Alternate regimen: Fexinidazole po od
  • 1.1.2 Pediatric
  • Preferred regimen: Suramin 20 mg/kg IV on days 1, 3, 5, 14, and 21
  • 1.2 T. b. rhodesiense, CNS involvement
  • 1.2.1 Adult
  • Preferred regimen: Melarsoprol 2-3.6 mg/kg/day IV for 3 days. After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days
  • 1.2.2 Pediatric
  • Preferred regimen: Melarsoprol 2-3.6 mg/kg/day IV for 3 days. After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days
  • 2. West African trypanosomiasis
  • 2.1 T. b. gambiense, hemolymphatic stage
  • 2.1.1 Adult
  • Preferred regimen: Pentamidine 4 mg/kg/day IM/IV for 7-10 days
  • 2.1.2 Pediatric
  • Preferred regimen: Pentamidine 4 mg/kg/day IM/IV for 7-10 days
  • Note (1): Pentamidine should only be used during pregnancy and lactation if the potential benefit justifies the potential risk
  • Note (2): IM/IV Pentamidine have a similar safety profile in children age 4 months and older as in adults. Pentamidine is listed as a medicine for the treatment of 1st stage African trypanosomiasis infection (Trypanosoma brucei gambiense) on the WHO Model List of Essential Medicines for Children, intended for use in children up to 12 years of age
  • 2.2 T. b. gambiense, CNS involvement
  • 2.2.1 Adult
  • Preferred regimen: Eflornithine 400 mg/kg/day IV qid for 14 days
  • 2.2.2 Pediatric

References

  1. Kennedy PG (2013). "Clinical features, diagnosis, and treatment of human African trypanosomiasis (African trypanosomiasis". Lancet Neurol. 12 (2): 186–94. doi:10.1016/S1474-4422(12)70296-X. PMID 23260189. Text "sleeping sickness) " ignored (help)
  2. Singh Grewal A, Pandita D, Bhardwaj S, Lather V (2016). "Recent Updates on Development of Drug Molecules for Human African Trypanosomiasis". Curr Top Med Chem. 16 (20): 2245–65. PMID 27072715.
  3. Priotto G, Fogg C, Balasegaram M, Erphas O, Louga A, Checchi F, Ghabri S, Piola P (2006). "Three drug combinations for late-stage Trypanosoma brucei gambiense sleeping sickness: a randomized clinical trial in Uganda". PLoS Clin Trials. 1 (8): e39. doi:10.1371/journal.pctr.0010039. PMC 1687208. PMID 17160135.
  4. 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.
  5. "African Trypanosomiasis".

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