Table 1.

Current Drugs for the treatment of HAT

Drug	Use	Limitations	Mechanism of action	Dosing
Suramin	T. b. rhodesiense early stage only	Does not cross the blood brain barrier; toxicity	unknown	IV injection 100- 200 mg test dose then 1 g given on days 1, 3, 7, 14 and 21
Pentamidine	T. b. gambiense, early stage only	Does not cross the blood brain barrier	unknown	IM injection in single doses of 4.0 mg/kg per day for 7 days
Melarsoprol	Late Stage T. b rhodesiense; Late stage T. b. gambiense if eflornithine is unavailable	Severe toxicity – causes reactive enceplapthy resulting in death in up to 6% of patients	unknown	T.b. rhodesiense, 3 series of 3 daily doses IV with a 7 day rest period in between: 1.8, 2.7 and 3.6 mg/kg on days 1, 2, and 3 respectively with subsequent series at 3.6 mg/kg daily; T. b. gambiense, 2.2 mg/kg/day IV for 10 days
Eflornithine	Late state T. b gambiense	Not effective against T. b rhodesiense; difficult dosing regime requiring prolong i.v. administration	Mechanism based inhibitor of ornithine decarboxylase	400 mg/kg/day in divided doses IV every 6 h for 14 days
Nifurtimox/ Eflornithine (NECT)	Late stage T. b gambiense	Not effective against T. b rhodesiense	MOA of nifurtimox – activated by a NADH- dependent mitochondrial nitroreductase leading to the generation of intracellular free radicals[169]	eflornithine 400 mg/kg/ day IV in divided doses every 12 h for 7 days and nifurtimox 15 mg/kg/day orally every 8 h for 10 days