Treatment of Gambiense Human African Trypanosomiasis in Patients Aged ≥6 Years and Body Weight ≥20 kg Without Severe Meningo-Encephalitic Features

Clinical Scenario

This protocol applies to gambiense human African trypanosomiasis (HAT) in patients meeting all of the following criteria:

Age ≥6 years
Body weight ≥20 kg
No clinical signs of severe meningo-encephalitic disease, or CSF white blood cell count <100/µL

Treatment Approach

The regimen for this population involves a defined combination therapy as the primary approach. For patients who meet specific eligibility thresholds, additional single-agent alternatives are available — including one used under compassionate use arrangements. The complete selection criteria, sequencing, and all therapy options are in the full protocol.

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References

Fexinidazole is therefore the first-choice treatment in gambiense HAT patients aged ≥6 years and body weight ≥20 kg presenting without clinical features consistent with severe meningo-encephalitic HAT or presenting with <100 WBC/µL in CSF.

If after NECT the patient relapses, the first rescue treatment should be NECT-long, which comprises eflornithine infusions (400 mg/kg per day in two infusions) for a total of 14 days.

Nifurtimox is given for 10 days, exactly as in the NECT schedule.

The treatment alternatives are eflornithine monotherapy at 100 mg/kg every 6 hours (400 mg/kg per day) for 14 days, or fexinidazole if age/weight appropriate and WBC in CSF <100 cells (compassionate use).

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