This protocol covers a specific sub-population: patients with confirmed gambiense HAT who are either younger than 6 years or weigh less than 20 kg, and whose cerebrospinal fluid has a white blood cell count of 5/µL or fewer with no trypanosomes detected.
Management involves a combination regimen known as NECT, pairing an oral agent with an intravenous infusion component administered over separate, defined durations.
Pentamidine is the first-choice treatment in gambiense HAT patients aged < 6 years or body weight < 20 kg presenting with ≤ 5 WBC/µL and no trypanosomes in CSF.
If a patient treated with pentamidine relapses, fexinidazole or NECT should be administered depending on the patient's age/weight and the CSF WBC count.
NECT consists of oral nifurtimox and intravenous eflornithine (α-difluoromethylornithine or DFMO): nifurtimox 15 mg/kg per day orally in three doses for 10 days; eflornithine 400 mg/kg per day intravenously in two 2-hour infusions (each dose diluted in 250 mL of water for injection) for 7 days.