Benznidazole Chagas’ disease

The drugs used for T. cruzi include nifurtimox (Lampit) and benznidazole (Rochagan). Oral nifurtimox is available from the CDC, while benznidazole is only available in Brazil. The adult dose of nifurtimox is 8 to 10 mg/kg per day in divided doses for 120 days. Since children seem to tolerate the dose better than adults, the pediatric dose of nifurtimox in children 1 to 10 years old is 15 to 20 mg/kg per day, and the dose for children 11 to 16 years old is 12.5 to 15 mg/kg per day in divided doses. Symptomatic treatment for heart failure associated with Chagas disease should be initiated. The gastrointestinal complications may require surgical revisions and reconstruction. 

Benznidazole is an orally administered nitroimidazole that appears to have efficacy similar to that of nifurtimox in the treatment of acute Chagas disease. Availability of the drug is currently limited. Important toxicities include peripheral neuropathy, rash, gastrointestinal symptoms, and myelosuppression. 

Viotti R et al. Long-term cardiac outcomes of treating chronic Chagas disease with benznidazole versus no treatment A nonrandomized trial. Ann Intern Med 2006 144 724. [PMID 16702588]... 

Like metronidazole, benznidazole is mutagenic. In tests for chromosomal aberrations and induction of micronuclei in cultures of peripheral lymphocytes from children with Chagas disease, there were increases in micro-nucleated interphase lymphocytes and of chromosomal aberrations after treatment with benznidazole (4). 

Sosa Estani S, Segura EL, Ruiz AM, Velazquez E, Porcel BM, Yampotis C. Efficacy of chemotherapy with benznidazole in children in the indeterminate phase of Chagas disease. Am J Trop Med Hyg 1998 59(4) 526-9. 

Cancado JR. Long term evaluation of etiological treatment of Chagas disease with benznidazole. Rev Inst Med Trop Sao Paulo 2002 44(l) 29-37. 

Castro JA, Diaz de Toranzo EG. Toxic effects of nifurtimox and benznidazole, two drugs used against American trypanosomiasis (Chagas disease). Biomed Environ Sci 1988 l(l) 19-33. 

This has been translated into clinical benefits. There have been several reports of the efficacy of allopurinol in visceral leishmaniasis and one study using allopurinol riboside in cutaneous leishmaniasis. More recently, a controlled study in Colombia has documented the efficacy of allopurinol in cutaneous leishmaniasis (20). In this study the cure rate of allopurinol was 80% compared to 74% using allopurinol and glucantime together. The cure rate of glucantime alone was 36%. A similar study of the efficacy of allopurinol in chronic asymptomatic Chagas disease showed that allopurinol in doses of 600 or 900 mg day was equal efficacy to nifurotimox or benznidazole (21). 

Nifurtimox and benznidazole are used to treat American trypanosomiasis (Chagas disease) caused by T. cruzi. Because of toxicity, benznidazole is preferred. Both drugs markedly reduce the parasitemia, morbidity, and mortality of acute Chagas disease, producing parasitological cures... 

Benznidazole is the second of the drugs approved for treatment of Chagas disease. Like nifurtimox, it is effective against the circulating form of Trypanosoma cruzi during the acute phase of the disease, but also like nifurtimox, it is ineffective during the chronic stage of the disease. 

Viotti R, Vigliano C, Armenti H et al. Treatment of chronic Chagas disease with benznidazole Clinical and serological evolution of patients with long-term follow-up. Am Heart J 1994 127 151-62. 

Araujo MS, Martins-Filho OA, Pereira ME et al. A combination of benznidazole and ketoconazole enhances efficacy of chemotherapy of experimental Chagas disease. J Antimicrob Chemother 2000 45 819-24. 

Pinazo M-J, Munoz J, Posada E, Lopez-Chejade P, Gfflego M, Ayala E, del Cacho E, Soy D, Gascon J. Tolerance of benznidazole in treatment of Chagas disease in adults. Antimicrob Agents Che-mother 2010 54(11) 4896-9. 

Viotti R, Vigliano C, Alvarez MG, Petti M, Bertocchi G, Armenti A. Side effects of benznidazole as treatment in chronic Chagas disease fears and realities. Expert Rev Anti Infect Ther 2009 7(2) 157-63. 

Chaga s disease, caused by the parasite Trypanosoma cruzi, is endemic in Latin America, and represents a very serious public health problem in several countries. At present, the only available therapeutic agent for Chaga s disease is benznidazole. This nitroheterocyclic compound is not... 

American trypanosomiasis (Chaga s disease) Trypanosoma cruzi Nifurtimox, benznidazole... 

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