Table 1.
Indication of treatment against Trypanosoma cruzi infection based on different levels of quality of evidences and tools to assess efficacy or failure.
Indication (strength of the recommendation, and level of evidence) | Drug | Efficacy† | Time elapsed | Failure‡ | Comments |
---|---|---|---|---|---|
Acute phase: vector transmission ((A) I) [10] Congenital transmission ((A) II) [11–15] |
Bz, Nftx | 65–100% | 8 months or more | 5% | Medium term of followup to asses efficacy Good tolerance |
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Early chronic phase (children) ((A) I) [16–22] | Bz | 50–70% | 3–15 years | 5% | Most of the cases were children under 12 yo. Long term of followup to asses efficacy Good tolerance Different response for T. cruzi lineage I and II Some resistant clones were observed |
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Late chronic phase (adults, indeterminate, cardiac/digestive/other diseases) ((B) II; (C) II) [7, 18, 23–31] | Bz, Nftx | 30% | >20 years | 10% | Long term of followup Frequent side effects Efficacy to prevent evolution is under research Moderate-bad tolerance Different response for T. cruzi lineage I and II Some resistant clones were observed |
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Pregnant ((E) III) [32, 33] | NA | NA | NA | NA | Some accidental or necessary treatment during pregnant with acute phase did not show damaging effect in the child Treatment of pregnant women is currently not recommended [7, 9] |
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Immunocompromised (i.e., HIV, Transplant, other) ((A) II) [34–40] | Bz, Nftx | ND | ND | <5% | Etiological treatment aborts severe forms of reactivation as meningoencephalitis, myocarditis, panniculitis, and so forth, Good response No evidence about prophylaxis. Under research |
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Accidents ((B) III) [33] | Bz, Nftx | NA | NA | NA | 10–15 days treatment immediately after accidents avoid infection |
†Maximum rate of seronegativization.
‡Maximum rate of positive parasitologic test after treatment.
Bz: benznidazole, NA: not applicable, ND: no data, Nftx: nifurtimox.