As a result of globalization and constant migratory flows, Chagas disease is now present in almost all continents. The management and treatment of the disease is often influenced by the economic and social context of the societies that host patients. In this manuscript, we aim to provide a comparative review of approaches to patients with Chagas disease in the Americas and Europe.
Key words:
Chagas disease; treatment; benznidazole; nifurtimox
| Benznidazole | Nifurtimox | Grades of recommendation levels of evidence | ||
| Acute infections | Congenital | 10 mg/kg per day in 2 to 3 daily doses for 60 days | 10-15 mg/kg per day in 2 to 3 daily doses for 60 days | AIII |
| Vectorial and oral | Children (≤ 40 kg): 7.5-10 mg/kg per day in 2 to 3 daily doses for 60 days | Children (≤ 40 kg): 10-15 mg/kg mg/kg per day in 2 to 3 daily doses for 60 days | AIII | |
| Adults (> 40 kg): 5-7 mg/kg per day in 2 to 3 daily doses for 60 days | Adults (> 40 kg): 8-10 mg/kg per day in 2 to 3 daily doses for 60 days | AIII | ||
| Laboratory accident | 5-7 mg/kg per day in 2 to 3 daily doses for 10-14 days | 8-10 mg/kg per day in 2 to 3 daily doses for 10-14 days | AIII | |
| Post-transfusion or transplant from an infected donor | 5-7 mg/kg per day in 2 to 3 daily doses for 60 days | 8-10 mg/kg per day in 2 to 3 daily doses for 60 days | AIII | |
| Chronic infections | Immunocompetent patient | Children (≤ 40 kg): 7.5-10 mg/kg per day in 2 to 3 daily doses for 60 days | Children (≤ 40 kg): 10-15 mg/kg mg/kg per day in 2 to 3 daily doses for 60 days | |
| Adults (> 40 kg): 5-7 mg/kg per day in 2 to 3 daily doses for 60 days | Adults (> 40 kg): 8-10 mg/kg per day in 2 to 3 daily doses for 60 days | |||
| Special situations | HIV infected patients | Same posology as immunocompetent patient. Primary prophylaxis benznidazole (200mg/ day or 5 mg/kg/day three times a week) until the CD4 lymphocyte count reaches 200-250 cells/mL and viral load is undetectable for at least 6 months in a patient on stable antiretroviral therapy. | BIII | |
| Reactivation (HIV or transplant recipients) | Benznidazole 5-7.5 mg/kg per day in 2 to 3 daily doses for 60 days | Nifurtimox 8-10 mg/kg per day in 2 to 3 daily doses for 60 - 90 days | AIII | |
| Higher doses in the case of CNS involvement (15 mg/kg/day). Secondary prophylaxis benznidazole (200mg/ day or 5mg/kg/day three times a week) until the CD4 lymphocyte count reaches 200-250 cells/mL and viral load is undetectable for at least 6 months in a patient on stable antiretroviral therapy (in the case of HIV patients) | ||||
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