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New WHO guidelines for treatment of gambiense human African trypanosomiasis including fexinidazole: substantial changes for clinical practice.

  • Lindner AK Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Institute of Tropical Medicine and International Health, Berlin, Germany.
  • Lejon V Intertryp, Institut de Recherche pour le Développement, CIRAD, University of Montpellier, Montpellier, France. Electronic address: veerle.lejon@ird.fr.
  • Chappuis F Hôpitaux Universitaires de Genève, Geneva, Switzerland.
  • Seixas J Institute of Hygiene and Tropical Medicine and Global Health and Tropical Medicine R&D Center, NOVA University, Lisbon, Portugal.
  • Kazumba L Neurology Department, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
  • Barrett MP Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, UK.
  • Mwamba E National HAT Control Program, Ministry of Health, Kinshasa, Democratic Republic of the Congo.
  • Erphas O National HAT Control Program, Ministry of Health, Kampala, Uganda.
  • Akl EA AUB GRADE Center, Center for Systematic Reviews in Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon.
  • Villanueva G Cochrane Response, London, UK.
  • Bergman H Cochrane Response, London, UK.
  • Simarro P Neglected Tropical Diseases Department, World Health Organization, Geneva, Switzerland.
  • Kadima Ebeja A World Health Organization Office for the Democratic Republic of Congo, Kinshasa, Democratic Republic of Congo.
  • Priotto G Neglected Tropical Diseases Department, World Health Organization, Geneva, Switzerland.
  • Franco JR Neglected Tropical Diseases Department, World Health Organization, Geneva, Switzerland.
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  • 2019-12-28
Published in:
  • The Lancet. Infectious diseases. - 2020
Adolescent
Adult
Aged
Aged, 80 and over
Antiprotozoal Agents
Child
Child, Preschool
Eflornithine
Female
Humans
Infant
Infant, Newborn
Male
Middle Aged
Nifurtimox
Nitroimidazoles
Practice Guidelines as Topic
Trypanosoma brucei gambiense
Trypanosomiasis, African
World Health Organization
Young Adult
English Human African trypanosomiasis caused by Trypanosoma brucei gambiense is a parasitic infection that usually progresses to coma and death unless treated. WHO has updated its guidelines for the treatment of this infection on the basis of independent literature reviews and using the Grading of Recommendations Assessment, Development and Evaluation methodology. The first-line treatment options, pentamidine and nifurtimox-eflornithine combination therapy, have been expanded to include fexinidazole, an oral monotherapy given a positive opinion from the European Medicines Agency. Fexinidazole is recommended for individuals who are aged 6 years and older with a bodyweight of 20 kg or more, who have first-stage or second-stage gambiense human African trypanosomiasis and a cerebrospinal fluid leucocyte count less than 100 per μL. Nifurtimox-eflornithine combination therapy remains recommended for patients with 100 leucocytes per μL or more. Without clinical suspicion of severe second-stage disease, lumbar puncture can be avoided and fexinidazole can be given. Fexinidazole should only be administered under supervision of trained health staff. Because these recommendations are expected to change clinical practice considerably, health professionals should consult the detailed WHO guidelines. These guidelines will be updated as evidence accrues.
Language
  • English
Open access status
green
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Persistent URL
https://folia.unifr.ch/global/documents/103703
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