TABLE 7.

Recommendations for antitrypanosomal drug treatment according to Chagas disease phase and form, patient age, and clinical status

Recommendation on antitrypanosomal drug treatment by Chagas disease phase, form, and demographic group	Strength of recommendation; quality of evidencea
Should always be offered
Acute T. cruzi infection (including congenital infection in 1st mo of life)	Strong; moderate
Children ≤12 yrs old with chronic T. cruzi infection	Strong; high
Children 13–18 yrs old with chronic T. cruzi infection	Strong; low
Reactivated T. cruzi infection in immunosuppressed patient	Strong; moderate
Reproductive-age women planning future pregnancies	Strong; moderate
May be offered with consideration of potential risks and benefits, uncertainties, and patient preferences
Adults with normal ECG and cardiac function	Discretionary; weak
Adults with early signs of cardiomyopathy	Discretionary; weak
Recommendation against treatment
During pregnancy	Strong; weak
During lactation	Weak; weak
Patients with advanced cardiomyopathy	Strong; moderate
Patients with gastrointestinal Chagas disease that impairs absorption	Weak; weak

^aBased on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system (343). The GRADE system offers only two grades of recommendations: “strong” and “weak” or “discretionary.” Strong recommendations are provided when the balance of desirable versus undesirable effects is clear. Weak or discretionary recommendations require an assessment of the evidence and decision making based on a consideration of potential risks and benefits, uncertainties, and patient preferences (344).