Therapy of Chagas Disease: Implications for Levels of Prevention

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
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
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
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]
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
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.