Table 5.

Current alternative therapeutical options for management of trypanocidal resistance.

Trypanocidal agent	Trade names	Structure	Route of administration	Dosage (mgkg −1 ) b	Targeted trypanosome species	Adverse/side effects	Management of relapses
Diminazene aceturate	Berenil, Ganaseg Trypan Veriben Azidin Pirocide,		IM	3.5, 8 for resistant trypanosomes, 5-10 for T.b.evans.	T.congolense, T.vivax Less effective on T.b.brucei and T. evans	Has toxic effects in camels, horses, donkeys, and dogs, camels.	Isometamidium chloride
Isometamidium chloride	Veridium, Trypamidium, Securidium Samorin,		IM	0.25-1	T. congolense, T. vivax less effective on T. b. brucei and T. b. evansi	Avoid subcutaneous administration. Highly painful, inflammation at site of injection in cattle, and highly cytotoxic at doses above 2mgkg_1.	DA
Homidium bromide	Ethidium, Novidium		IM, IV	1	T. vivax T.congolense. low efficacy on T. b. bucei infection in livestocks	Administation via IM cause toxic effcets to horses. It is highly carcinogenic	DA and Isometamidium chloride
Quinapyramine sulphate	Antrycide, Triquin-S Trypacide, tribexin, Noroquin, and quintricide,		SC	3-5 and 20-40 for T.simiae.	T.b. evansi T.vivax T. congolense T. brucei T. b. equiperdum T. simiae/ camels	Highly toxic at doses. High chances of resistances	Isometamidium. Suramin sodium
Melarsomine dihydrochloride		IM	0·25-0.5	T.b.evansi in camels	Has self-limiting side effects and immediate	Isometamidium.
Melarsoprol	Mel B, Melarsen Oxide-BAL, Arsobal		IV, given slowly	2-3.6, given for three days After 1 week: 3.6 for 3 days Repeat again after 10-21 days: 3.6 mg/kg/day (69)	Trypanosoma brucei rhodesiense	Administered only in severe cases. Brain dysfunction, encephalopathy, convulsions, loss of consciousness, bloody stools, nausea, fever, vomiting, rashes, numbness, rashes, renal and liver disorders are all common adverse effects. It is not suggested for usage in pregnant women	eflornithine
Eflornithine	Vaniqas		IV, administered slowly/ short tern infusions	100, given at 6 h interval for 14 days - 150, in (children)	T. b. gambiense	Bone marrow suppression resulting into anemia, leucopenia and thrombocytopenia, cancer, and alopecia, hypoacusis Best for patients above 12 years of age	NECT
Pentamidine (113) Other names: pentamidine diisethionate, pentamidine dimesilate	For oral inhalation and for nebulizer use: •NebuPent Nebulizer (APP Pharmaceuticals LLC, United States) For IV and IM •United States and Canada: ° Pentacarinat 300 ° Pentam 300 ° Pentamidine isethionate 300 mg		IV, IM, inhalation	4 given IV/IM q d for 14–21 d	For early stage of T. b. gambiense	For the injectable formula: low blood sugar, irritation at the sit of injection, vomiting, nausea, low blood pressure, and kidney problems occur. For inhaled formula; patients experience nausea, wheezing, and cough, nausea Others may include; chest pain and skin rash	Eflornithine or melarsoprol
Suramin sulphate	Naganol, Bayer 205, Germanin		IV, Given as 3 doses per week in horses	A dose of 10mg Taken every 5 days to total of 12 injections for T. b. gambiense Adult: 100-200 mg (test dose) (IV), then 1 g IV on days 1, 3, 7, 14, 21 Pediatric: 20 mg/kg- 1 g/dose IV on days 1, 3, 7, 14, 21; not to exceed	T.b. brucei, T.b. evansi, T.b. equiperdum	IM causes necrosis at the site. Cause toxicity in horses. Others include; Vomiting, Hives, Numbness and tingling, Nerve pain in extremities, Kidney damage, Blood disorders, pancytopenia, Shock, Optic atrophy	Quinapyramine sulphate
Nifurtimox	Lampit by Bayer		oral	recommended doses are 5 mg/kg per os three times/day for adults and 7 mg/kg three times/day for children for 14–21 days. 30 mg/kg/d for 30 d	Trypanosoma brucei gambiense	Diarrhea, convulsions, vomiting epilepticus and Reversible cerebellar syndrome (ataxia, nystagmus, tremors, and vertigo) was seen with high dose (30 mg/kg/day for 30 days).	NECT