Coura J R
Departamento de Medicina Tropical, Instituto Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brasil.
Bol Chil Parasitol. 1996 Jul-Dec;51(3-4):69-75.
The evolution of the specific treatment of Chagas' disease, including the numerous drugs tested, is briefly summarized. Since 1969 laboratory and clinical studies have persistently demonstrated that nifurtimox (NFX) and benznidazole (BNL) are the best agents for treating Trypanosoma cruzi human infection, even though they cannot be considered ideal drugs. The main indications for NFX and BNL are: acute phase of the infection, congenital form, reactivation associated with immunosuppression, recently acquired infection, mostly in children and young adults, and in transfusions and organ transplant situations. Both drugs may also be indicated for the treatment of some patients in the undetermined asymptomatic form of the chronic infection with mild heart involvement, or in clinical megaesophagus patients who previously need symptomatic treatment to ensure the appropriate absorption of the medication. The most used dosage schedules are: NFX for 60-90 days, 8-10 mg/kg/day in adults and < 15 mg/kg/day in children. BNL, for 60 days, 5 mg/kg/day in adults and < 10 mg/kg/day in children. Both drugs are taken orally and must be given divided into 2-3 fractions after meals. Both drugs are well tolerated by children, and particularly in the acute phase of the disease. Adverse reactions may be observed, i.e. disturbances associated to the digestive tract such as hyporexia, nausea, vomiting and loss of weight with NFX, and dermopathy and polyneuropathy, with BNL. The main limitations of both drugs are in the long course of administration and the occurrence of adverse side effects. A series of promising new drugs for the treatment of human Chagas' disease is being tested. Because the relative lack of interest of the pharmaceutical industry in the research for new drugs for the treatment of the parasitosis--which affects 16-18 million people in Latin America--Universities and Research Governmental Institution should stimulate the investigation for the development of new drugs and the clinical evaluation of drugs experimentally known and not yet tested.
本文简要总结了恰加斯病特异性治疗方法的演变，包括所测试的众多药物。自1969年以来，实验室和临床研究一直表明，硝呋莫司（NFX）和苯硝唑（BNL）是治疗人类克氏锥虫感染的最佳药物，尽管它们并非理想药物。NFX和BNL的主要适应证为：感染急性期、先天性感染、与免疫抑制相关的再激活、近期获得性感染（主要见于儿童和年轻人）以及输血和器官移植情况。这两种药物也可用于治疗慢性感染未确定无症状形式且心脏受累较轻的部分患者，或用于临床巨食管患者，这些患者此前需要对症治疗以确保药物的适当吸收。最常用的给药方案为：NFX治疗60 - 90天，成人8 - 10mg/kg/天，儿童<15mg/kg/天。BNL治疗60天，成人5mg/kg/天，儿童<10mg/kg/天。两种药物均口服，且必须在饭后分2 - 3次服用。儿童对这两种药物耐受性良好，尤其是在疾病急性期。可能会观察到不良反应，即与消化道相关的紊乱，如NFX引起的食欲减退、恶心、呕吐和体重减轻，以及BNL引起的皮肤病和多发性神经病。这两种药物的主要局限性在于给药疗程长且会出现不良副作用。一系列有前景的治疗人类恰加斯病的新药正在进行测试。由于制药行业对治疗这种寄生虫病新药研究的兴趣相对缺乏（该病在拉丁美洲影响1600 - 1800万人），大学和政府研究机构应推动新药研发调查以及对已知但尚未测试的实验性药物进行临床评估。
