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Abstract
From the first decade of this century arsenicals have been the most universal and
most effective drugs for all cases of sleeping sickness. Melarsoprol, introduced in
the 1940s, remains the most universal of these compounds. However, resistance of trypanosomes
and toxicity that may be fatal for the patient are two major shortcomings. Pentamidine,
suramin and Berenil((R)) are active only in the first stage of the disease, when the
parasites are confined to blood and lymph. Nifurtimox taken orally for 1 to 2 months
and alpha-difluoro-methylornithine (alpha-DFMO) with an administration scheme spread
over 5 weeks including 14 days of intravenous injections. provide interesting alternatives
for all cases, since they reach the central nervous system. However, DFMO is known
to be less active against. T. rhodesiense. Imidazoles, new arsenical derivatives and
antimitotics have been successfully tested in experimental models. Combinations of
drugs with additive or pontentiating effects mainly based on inhibition of decarboxylase
enzymes or exposure to axidative stress appear promising.