African trypanosomiasis medical therapy: Difference between revisions
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==Overview== | ==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 [[African trypanosomiasis|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. | 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 [[Centers for Disease Control and Prevention|CDC]] Drug Service) are the drugs of choice to treat the hemolymphatic stages of West and [[African trypanosomiasis|East African Trypanosomiasis]], respectively. [[Melarsoprol]] is the drug of choice for late disease with [[central nervous system]] involvement (infections by ''[[Trypanosoma brucei gambiense|T.b. gambiense]]'' or ''[[Trypanosoma brucei rhodesiense|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.<ref name="pmid23260189">{{cite journal |vauthors=Kennedy PG |title=Clinical features, diagnosis, and treatment of human African trypanosomiasis (African trypanosomiasis|sleeping sickness) |journal=Lancet Neurol |volume=12 |issue=2 |pages=186–94 |year=2013 |pmid=23260189 |doi=10.1016/S1474-4422(12)70296-X |url=}}</ref><ref name="pmid27072715">{{cite journal |vauthors=Singh Grewal A, Pandita D, Bhardwaj S, Lather V |title=Recent Updates on Development of Drug Molecules for Human African Trypanosomiasis |journal=Curr Top Med Chem |volume=16 |issue=20 |pages=2245–65 |year=2016 |pmid=27072715 |doi= |url=}}</ref><ref name="pmid17160135">{{cite journal |vauthors=Priotto G, Fogg C, Balasegaram M, Erphas O, Louga A, Checchi F, Ghabri S, Piola P |title=Three drug combinations for late-stage Trypanosoma brucei gambiense sleeping sickness: a randomized clinical trial in Uganda |journal=PLoS Clin Trials |volume=1 |issue=8 |pages=e39 |year=2006 |pmid=17160135 |pmc=1687208 |doi=10.1371/journal.pctr.0010039 |url=}}</ref><ref name="pmid16080099">{{cite journal |vauthors=Chappuis F, Udayraj N, Stietenroth K, Meussen A, Bovier PA |title=Eflornithine is safer than melarsoprol for the treatment of second-stage Trypanosoma brucei gambiense human African trypanosomiasis |journal=Clin. Infect. Dis. |volume=41 |issue=5 |pages=748–51 |year=2005 |pmid=16080099 |doi=10.1086/432576 |url=}}</ref> | ||
==Medical Therapy== | ==Medical Therapy== | ||
| Line 13: | Line 13: | ||
::::* 1.1.1 '''Adult ''' | ::::* 1.1.1 '''Adult ''' | ||
:::::* Preferred regimen: [[Suramin]] 1 gm IV on days 1, 3, 5, 14, and 21 | :::::* Preferred regimen: [[Suramin]] 1 gm IV on days 1, 3, 5, 14, and 21 | ||
:::::* Alternate regimen: Fexinidazole po od | |||
::::* 1.1.2 '''Pediatric''' | ::::* 1.1.2 '''Pediatric''' | ||
:::::* Preferred regimen: [[Suramin]] 20 mg/kg IV on days 1, 3, 5, 14, and 21 | :::::* Preferred regimen: [[Suramin]] 20 mg/kg IV on days 1, 3, 5, 14, and 21 | ||
| Line 23: | Line 24: | ||
:::* 2.1 '''''T. b. gambiense'', hemolymphatic stage''' | :::* 2.1 '''''T. b. gambiense'', hemolymphatic stage''' | ||
::::* 2.1.1 '''Adult''' | ::::* 2.1.1 '''Adult''' | ||
:::::* Preferred regimen: [[Pentamidine]] 4 mg/kg/day IM/ IV for 7-10 days | :::::* Preferred regimen: [[Pentamidine]] 4 mg/kg/day IM/IV for 7-10 days | ||
::::* 2.1.2 '''Pediatric''' | ::::* 2.1.2 '''Pediatric''' | ||
:::::* Preferred regimen: [[Pentamidine]] 4 mg/kg/day IM/IV for 7-10 days | :::::* Preferred regimen: [[Pentamidine]] 4 mg/kg/day IM/IV for 7-10 days | ||
:::::* Note (1): [[Pentamidine]] should only be used during pregnancy and | :::::* 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 | :::::* Note (2): IM/IV [[Pentamidine]] have a similar safety profile in children age 4 months and older as in [[Adult|adults]]. [[Pentamidine]] is listed as a medicine for the treatment of 1st stage African trypanosomiasis infection (''[[Trypanosoma brucei gambiense]]'') on the '''[[World Health Organization|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 '''''T. b. gambiense'', CNS involvement''' | ||
::::* 2.2.1 '''Adult''' | ::::* 2.2.1 '''Adult''' | ||
| Line 33: | Line 34: | ||
::::* 2.2.2 '''Pediatric''' | ::::* 2.2.2 '''Pediatric''' | ||
:::::* Preferred regimen: [[Eflornithine]] 400 mg/kg/day IV qid for 14 days | :::::* Preferred regimen: [[Eflornithine]] 400 mg/kg/day IV qid for 14 days | ||
:::::* Note (1): [[Eflornithine]] should only be used during pregnancy and lactation if the potential benefit | :::::* Note (1): [[Eflornithine]] should only be used during [[pregnancy]] and [[lactation]] if the potential benefit outweighs the potential risk | ||
:::::* Note (2): The safety of [[eflornithine]] in children has not been established. [[Eflornithine]] is not approved by the Food and Drug Administration (FDA) for use in pediatric patients. [[Eflornithine]] is listed for the treatment of 1st stage African trypanosomiasis in ''Trypanosoma brucei gambiense'' infection on the '''WHO model List of Essential Medicines for Children''', intended for use in children up to 12 years of age | :::::* Note (2): The safety of [[eflornithine]] in children has not been established. [[Eflornithine]] is not approved by the [[Food and Drug Administration]] ([[Food and Drug Administration|FDA]]) for use in [[pediatric]] patients. [[Eflornithine]] is listed for the treatment of 1st stage African trypanosomiasis in ''[[Trypanosoma brucei gambiense]]'' infection on the '''[[WHO]] model List of Essential Medicines for Children''', intended for use in children up to 12 years of age | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Dermatology]] | |||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Emergency medicine]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
Latest revision as of 20:19, 29 July 2020
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Risk calculators and risk factors for African trypanosomiasis medical therapy |
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
- Preferred regimen: Eflornithine 400 mg/kg/day IV qid for 14 days
- Note (1): Eflornithine should only be used during pregnancy and lactation if the potential benefit outweighs the potential risk
- Note (2): The safety of eflornithine in children has not been established. Eflornithine is not approved by the Food and Drug Administration (FDA) for use in pediatric patients. Eflornithine is listed for the treatment of 1st stage African trypanosomiasis in Trypanosoma brucei gambiense infection on the WHO model List of Essential Medicines for Children, intended for use in children up to 12 years of age
References
- ↑ 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)
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ "African Trypanosomiasis".