Treatment of Chagas

On August 29th, 2017 the FDA approved Benznidazole to treat Chagas Disease in children ages 2 to 12 years old with Chagas disease.  Nifurtimox can only be obtained through the Centers of Disease Control using a special investigational protocol. Antiparasitic treatment is most effective the younger the patient and the shorter the duration of the infection.

Treatment with benznidazole or nifurtimox can prevent or significantly delay the severe forms of cardiomyopathy that accompany the chronic phase of Chagas disease, and is recommended for adults up to age 50 with the indeterminate form of Chagas disease. Another advantage of treatment is that it virtually eliminates the possibility of future congenital transmission. Treatment for adults aged 51-60 should be considered on a case-by-case basis. For adults over age 60, treatment is less beneficial and not typically offered. Contraindications for treatment with benznidazole or nifurtimox include pregnancy, hepatic or renal failure, and advanced cardiomyopathy.

Benznidazole is considered the first-line treatment because it generally produces fewer side effects than nifurtimox. However, some patients who cannot tolerate benznidazole are able to complete treatment with nifurtimox. Benznidazole’s most common side effects are rash, peripheral neuropathy, nausea, headache, insomnia, and anorexia.

Nifurtimox is produced by Bayer, which donates two million tablets annually to the World Health Organization. The most common side effects are gastrointestinal, especially anorexia, weight loss, nausea, and vomiting. Nifurtimox can also produce insomnia, peripheral neuropathy, and amnesia. Anxiety and depression are psychiatric side effects which can occasionally be severe.

Recommended Dosages*

 AgeTotal Daily dosageduration
benznidazole<12 years5-7.5 mg/kg divided into 2 doses60 days
benznidazole≥12 years5-7 mg/kg divided into 2 doses60 days
nifurtimox≤ 10 years15-20 mg/kg divided into 2 doses90 days
Nifurtimox11-16 years12.5-15 mg/kg divided into 2 doses90 days
nifurtimox17 years or older8-10 mg/kg divided into 2 doses90 days

* Source: Centers for Disease Control

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