The present situation, challenges, and perspectives regarding the production and utilization of effective drugs against human Chagas disease

2 nd Brazilian Consensus on Chagas Disease, 2015

“…This epidemiological scenario brings challenges in the coming decades for the country to support control actions and establish a consistent plan in the Unified Health System [Sistema Único de Saúde (SUS)] for diagnosis, treatment, and comprehensive care of millions of people (38) , combined with epidemiological surveillance adjusted to this reality (15) (22) . It is nd Brazilian Consensus on Chagas Disease, 2015 presumed that up to 30% of chronically infected people are likely to develop cardiac alterations and up to 10% may experience digestive, neurologic, or mixed alterations.…”

“…Therefore, these questions bring the need to overcome operational problems of the health care network, which should be prepared for longitudinal management of this chronic condition. There is also a need to guarantee sustainable production of medicines, given the potential increase in the demand for specific treatment, and international agreements (38) . Extensive national discussion is therefore ongoing, to assess the inclusion of surveillance through mandatory reporting of human cases in the chronic phase in order to qualify the actions of both epidemiology and control, and health care.…”

“…Benznidazole is a well-tolerated drug (20) (38) (251) . Children generally have fewer adverse effects than adults and can tolerate higher doses (104) .…”

“…In April 2013, the 19 th Expert Committee on the Selection and Use of Essential Medicines of the WHO discussed and approved the addition of two new formulations of benznidazole in the essential drugs list for children (38) . Benznidazole is being increasingly prescribed for the antiparasitic treatment of Chagas disease, not only the expansion of indications based on evidence, but also as a result of increased demand in endemic and non-endemic countries with better structure of their national surveillance and healthcare systems (38) (294) (295) . Benznidazole (Class 1, level of evidence b) is produced as tablets of 100mg and 50mg (adults) and 12.5mg and 50mg (children) (20) (42) (313) .…”

“…The 100mg and 50mg benznidazole tablets are distributed in Latin America by the Argentine Endocrine Laboratory (ELEA, Maprimed) and the PAHO Revolving Fund; in Spain, through the Spanish Agency for Medicines and Health Products; and the rest of the world through the ELEA and the WHO (38) . In Brazil, it is acquired by the Ministry of Health, and distributed to State Health Secretariats (SES) upon request in the Information Strategic Procurement System (SIES).…”