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

Lindner, A. K. et al. (2020) New WHO guidelines for treatment of gambiense human African trypanosomiasis including fexinidazole: substantial changes for clinical practice. Lancet Infectious Diseases, 20(2), e38-e46. (doi: 10.1016/S1473-3099(19)30612-7) (PMID:31879061)

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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.

Item Type:Articles
Additional Information:Funding for the development of these guidelines was provided by WHO.
Glasgow Author(s) Enlighten ID:Barrett, Professor Michael
Authors: Lindner, A. K., Lejon, V., Chappuis, F., Seixas, J., Kazumba, L., Barrett, M. P., Mwamba, E., Erphas, O., Akl, E. A., Villanueva, G., Bergman, H., Simarro, P., Kadima Ebeja, A., Priotto, G., and Franco, J. R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:Lancet Infectious Diseases
Publisher:Lancet Publishing Group
ISSN (Online):1474-4457
Published Online:23 December 2019
Copyright Holders:Copyright © 2019 Elsevier Ltd.
First Published:First published in Lancet Infectious Diseases 20(2): e38-e46
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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