2015, Issue 4
Two new protocols and one new review are available in Issue 4, 2015 of the Cochrane Database of Systematic Reviews:
New review
- Tafenoquine for preventing relapse in people with Plasmodium vivax malaria (Rajapakse S, Rodrigo C, Fernando SD) Link to review
Tafenoquine is an 8-aminoquinoline and a synthetic analogue of primaquine, which is the only licensed drug capable of eliminating the Plasmodium vivax hypnozoites. Tafenoquine has been tested as an alternative to primaquine as it has potential to be useful in regimens for prophylaxis and radical cure of P. vivax malaria. Tafenoquine has shorter duration of therapy and this makes it an attractive option to improve adherence. A Sri Lankan author team led by Senaka Rajapakse, identified three RCTs conducted in Thailand, India, Peru and Brazil on adults with confirmed P. vivax malaria that randomized 453 participants, for inclusion in the review. All participants received chloroquine (to clear the parasites in the blood) and some groups received either tafenoquine, primaquine or no further treatment. All trials tested people for G6PD enzyme, and excluded patients who were deficient, as both primaquine and tafenoquine can cause haemolysis in these individuals. Patients receiving tafenoquine at doses greater than 300 mg had fewer relapses than adults who had no further treatment, and tafenoquine 600 mg may be better in relapse prevention than standard primaquine doses. The drug is still untested in pregnancy, children and in G6PD-deficient people.
New protocols
- Mosquito repellents for malaria prevention (Maia MF, Kliner M, Richardson M, Lengeler C, Moore SJ) Link to protocol
Interventions to control flies for preventing diarrhoea in children under five years of age (Das JK, Salam RA, Hoda M, Lassi ZS, Bhutta ZA) Link to protocol
2015, Issue 3
One new review is available in Issue 3, 2015 of the Cochrane Database of Systematic Reviews:
New review
- Circulating antigen tests and urine reagent strips for diagnosis of active schistosomiasis in endemic areas (chodo EA, Gopalakrishna G, Spek B, Reitsma JB, van Lieshout L, Polman K, Lamberton P, Bossuyt PMM, Leeflang MMG) Link to review
This new review prepared by Eleanor Ochodo and her team evaluates point-of-care (POC) tests for diagnosing schistosomiasis. POC tests include assays based on circulating antigen detection and urine reagent strip tests, which are quick and easier to use in the field, and, if they show sufficient diagnostic accuracy, they could replace conventional microscopy. This review evaluated urine reagent strip tests to detect active Schistosoma haematobium infection, with microscopy as the reference standard; and circulating antigen tests for detecting active Schistosoma infection in geographical regions endemic for Schistosoma mansoni or S. haematobium or both, with microscopy as the reference standard. 90 studies involving almost 200,000 people were included (88 from field settings in Africa). For detecting urinary schistosomiasis, urine strips for detecting blood were better than those detecting protein or white cells, and the parasite antigen test performance was worse than urine strips for detecting blood. For intestinal schistosomiasis, the circulating parasite antigen urine test detected many infections identified by microscopy, but wrongly labelled many uninfected people as positive. Studies were in general poorly reported.
2015, Issue 2
One new review, one updated review and two new protocols are available in Issue 2, 2015 of the Cochrane Database of Systematic Reviews:
New review
- Artemisinin-naphthoquine for treating uncomplicated Plasmodium falciparum malaria (Isba R, Zani B, Gathu M, Sinclair D) Link to review
The World Health Organization (WHO) recommends artemisinin-based combination therapy (ACT) for treating people with Plasmodium falciparum malaria. Five combinations are currently recommended, all administered over three days. Artemisinin-naphthoquine is a new combination developed in China, which is being marketed as a one-day treatment. This review prepared by Rachel Isba and colleagues compares the efficacy and safety of artemisinin-naphtoquine against established WHO-recommended ACTs regimes (3 days) , in adults and children suffering from P.falciparum malaria. Only 4 trials, all of low quality, enrolling 740 adults and children, met the inclusion criteria: 3 small trials compared artemisinin-naphthoquine to artemether-lumefantrine and one small trial compared it to dihydroartemisinin-piperaquine. Artemisinin-naphthoquine showed very low treatment failure in all trials; this is a promising result but it needs to be confirmed by larger multi-setting trials.
Updated review
- Primaquine or other 8-aminoquinoline for reducing Plasmodium falciparum transmission (Graves PM, Gelband H, Garner P) Link to review
This review by Patricia Graves, Helen Gelband and Paul Garner has been updated with a new search but no added trials and no change to conclusions. Primaquine (PQ)is an antimalarial drug which does not cure malaria illness, but is known to kill the gametocyte stage of the malaria parasite which infects mosquitoes when they bite humans. The World Health Organization (WHO) in 2010 recommended adding a single dose of PQ to malaria treatment in order to reduce malaria transmission and to contribute to malaria elimination; in 2013 the recommended dose of PQ was reduced to 0.25 mg/kg due to concerns about safety, especially in people with G6PD deficiency. The review includes 17 RCT and one quasi-RCT and aims to assess whether PQ, or an alternative 8AQ, alongside treatment for P. falciparum malaria reduces malaria transmission, and to estimate the frequency of severe or haematological adverse events. The authors conclude that in individual patients, PQ added to malaria treatments reduces gametocyte prevalence when given in doses greater than 0.4 mg/kg. Two small studies reported a strong reduction in infectiousness, but no trials assessed whether this policy has an impact on community malaria transmission. Overall the safety of PQ given as a single dose was poorly evaluated across all studies.
New protocols
- Intermittent preventive treatment for malaria in infants (Okafo O, Esu E, Oringanje C, Meremikwu MM) link to protocol
- Smectite for acute infectious diarrhoea in children (Pérez-Gaxiola G, Cuello-García CA, Pérez-Pico V) link to protocol
2015, Issue 1
One new review and one new protocol are available in Issue 1, 2015 of the Cochrane Database of Systematic Reviews:
New review
- Intermittent preventive antimalarial treatment for children with anaemia (Athuman M, Kabanywanyi AM, Rohwer AC) Link to review
Anaemia is a global problem, particularly in in children under five years in Africa and South-East Asia. Malaria is a common cause of anemia in these areas, and administering intermittent preventive antimalarial treatment (IPT) to children might reduce anaemia, as well as protect from new malaria infections, allow faster recovery from the illness, and help make the children less likely to succumb to other infections. Mwaka Athuman and her co-authors in this new review have included six randomised controlled trials which included 3847 participants; three trials were conducted in areas of low malaria endemicity and three in areas of high endemicity. In some trials, iron supplements were also given to children. In all trials there was a group that received IPT and a control group that were given a placebo. Although there were small benefits in haemoglobin levels when treating anaemic children with IPT, there was no effect on death or hospital admissions, irrespective of whether they received iron supplements. However, three of the six included trials were conducted in low endemicity areas where malaria transmission is low and thus any protective effect is likely to be modest.
New protocol
- Mefloquine for preventing malaria in pregnant women (R González, Ragna S Boerma, ,David Sinclair, John J Aponte, Feiko O ter Kuile, Clara Menéndez) link to protocol