How is Chagas disease (American trypanosomiasis) treated?

Updated: Apr 26, 2019
  • Author: Louis V Kirchhoff, MD, MPH; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

The goals of therapy in persons with T cruzi infection are to eliminate the parasites with specific drug treatment and to manage the signs and symptoms that result from the largely irreversible lesions associated with the disease. In 2017, benznidazole was approved by the FDA for the treatment of Chagas disease caused by T cruzi in children aged 2-12 years. Nifurtimox (see Medication), is available through the CDC Drug Service (phone number: 404‑639‑3670) for specific treatment of T cruzi infection. For the most part, both benznidazole and nifurtimox are limited in their capacity to effect parasitologic cure, especially in chronically infected patients. Moreover, it has not been established in properly structured trials that treatment of chronically infected persons with either benznidazole or nifurtimox improves outcomes. [142, 143, 144] Thus, the use of these drugs in such patients continues to be controversial.

The safety and efficacy of benznidazole were established in 2 placebo-controlled clinical trials in children aged 6-12 years. In the trials, antibody test results changed from positive to negative in approximately 55%-60% of children treated with benznidazole, compared with approximately 5%-14% who received placebo. An additional study of the safety and pharmacokinetics of benznidazole provided information for dosing recommendations in children as young as 2 years. [145]

The CDC recommends antiparasitic treatment for all cases of acute (ie, congenital) or reactivated Chagas disease and for chronic T cruzi in children up to age 18 years. The CDC also strongly recommends treatment for adults aged 50 years or younger with chronic infection who do not already have advanced Chagas cardiomyopathy. [146]


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