Studies on metabolic pathways in T. cruzi have in some cases revealed the reason for their susceptibility to drugs effective in vivo against this parasite. That is for example the case for nifurtimox and benznidazole (Fig. 17.1), the drugs currently used in the treatment of Chagas disease. These studies have also helped to understand the effect of antifungal azoles, which have been tested in clinical trials against Chagas disease. In other cases, studies on the metabolism of T. cruzi have shed light on potential targets for drug action (such as the acidocalcisomes) or have helped in the identification of compounds (such as bisphosphonates and prenyl transferase inhibitors) that could be of potential use against this disease. We should expect that the use of some of these compounds could result in an adequate treatment for the acute and chronic forms of Chagas disease. The advantage of some of these compounds is that many of them are under development for other uses by pharmaceutical companies and some are already FDA-approved.
The usefulness of specific anti-T. cruzi treatment of acute and chronic Chagasic patients suggests that treatment is always beneficial. Even if the situation exists that cardiopathy or megas are not prevented in all those treated, eradication of parasitemia will prevent transmission by blood transfusion and, in female children, congenital transmission years later.