2012, Issue 12

One new review is  available in Issue 12, 2012 of the Cochrane Database of Systematic Reviews: New review

• Drugs for treating giardiasis (Granados CE, Reveiz L, Uribe LG, Criollo CP) ) Link to review

Carlos Granados and co-authors in this new review (which supersedes the original review on drugs for giardiasis, published in 1998), examine the effects of different antibiotics for treating giardiasis. Giardia lambliais an intestinal protozoan parasite that can cause diarrhoea, abdominal pain, and other gastrointestinal symptoms, and is transmitted by ingesting faecally contaminated water or food. Giardiasis is more prevalent in developing countries, but can be found in many different parts of the world including Northern Europe and the USA.

The review includes 19 trials with 1817 participants, (1441 children), comparing the routine treatment for giardiasis, metronidazole for five to 10 days, with alternative drugs and regimens.   Most trials were small and of poor quality, and assessed parasitological rather than clinical outcomes. Albendazole was found to have similar effectiveness to metronidazole, with the advantage of a simplified regimen, and was likely to cause fewer side effects. There was not enough evidence regarding the use of mebendazole or tinidazole.  The authors conclude that large, good quality RCTs with clinical outcomes are needed.

2012, Issue 11

Three updated reviews and one  new protocol are  available in Issue 11, 2012 of the Cochrane Database of Systematic Reviews: Updated reviews

• Antimicrobials for treating symptomatic non-typhoidal Salmonella infection (Onwuezobe IA, Oshun PO, Odigwe CC ) Link to review

Ifeanyi Onwuezo and colleagues have completed a full update of this review, which was first published in 1999. This update involves revised methods, a new title, and a new author team.  The review now includes 12 trials with 767 participants, both adults and children, who had symptomatic non-typhoidalSalmonellainfection and who were treated with 10 different oral or parenteral antibiotics. Many included studies are quite old, and the most recent is from 1999.  The results show that in otherwise healthy people, treatment with antibiotics did not have any benefit over treatment with no antibiotics, but made it more likely that patients would continue to excrete the same organisms for up to one month after treatment. There is not enough evidence for very young people, very old people and people who are immunosuppressed. 

• Vaccines for preventing rotavirus diarrhoea: vaccines in use (Soares-Weiser K, MacLehose H, Bergman H, Ben-Aharon I, Nagpal S, Goldberg E, Pitan F, Cunliffe N) Link to review

This review was last updated in January 2012 with the addition of several new trials. Karla Soares-Weiser, Harriet MacLehose and co-authors have now changed some of the review outcomes, to reflect the different rotavirus vaccines’ efficacy and safety in countries with different mortality rates. The review now includes 41 trials with a total of 186,263 participants. Twenty-nine trials (101,671 participants) assessed RV1, and 12 trials (84,592 participants) evaluated RV5. The main conclusions have not changed: both RV1 and RV5 prevent episodes of rotavirus diarrhoea. The vaccine efficacy is lower in high-mortality countries, but, due to the higher burden of disease, the absolute benefit is higher in these settings. No increased risk of serious adverse events including intussusception was detected, but more surveillance studies are required to detect rare events associated with vaccination.

• Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin and school performance (Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P)Link to review

This review had a substantive update in May 2012. David Taylor-Robinson and his team have now changed some of the GRADE assessments of the quality of the evidence for several outcomes, with most changes towards higher quality evidence. They have also updated the summary of findings. However, the main conclusions of the review remain that there is insufficient information to justify contemporary deworming programmes based on evidence of consistent benefit on nutrition, haemoglobin, school attendance or school performance.

New protocol

• Community based interventions for reducing dengue incidence (Muhamad NA, Abdullah NA, Ujang N, Elias A, Ho JJ, Awang S) Link to protocol

2012, Issue 10

One new review and one  new protocol are  available in Issue 10, 2012 of the Cochrane Database of Systematic Reviews:

• Antiobiotics for treating human brucellosis   (Yousefi-Nooraie R, Mortaz-Hejri S, Mehrani M, Sadeghipour P ) Link to review

Reza Yousefi-Nooraie and co-authors in this new review examine the effects of various antibiotic regimens for treating human brucellosis. This is the most common zoonotic disease worldwide, especially relevant in the Middle East, Central Asia, Africa, and Latin America.  People get infected through eating unpasteurized or raw milk, or other dairy products, but brucellosis is also an occupational disease in veterinarians and other animal health workers. Initial symptoms are non-specific (fever, fatigue) but if untreated the infection can progress to the musculoskeletal, reproductive and nervous system.  The review includes 25 small studies of variable quality. The analysis shows that doxycycline for 6 weeks plus streptomycin for 2-3 weeks is more effective than doxycycline plus rifampicin for 6 weeks.  Since treatment requires daily intramuscular injections, access to care and cost are important factors in deciding between the two. Quinolone plus rifampicin for 6 weeks is also well tolerated and effective. All included studies were in adults, and the authors recommend that good quality RCTs in children and in complicated brucellosis are needed.

New protocol

• TMC207 for treatment of people with pulmonary tuberculosis  (Rosa B, Cavalcanti Rolla V, Alves da Cunha AJL, Fermandes de Paulo R, Medronho RA, Atallah AN) Link to protocol

2012, Issue 9

One new review, one updated  review and one  new protocol are  available in Issue 9, 2012 of the Cochrane Database of Systematic Reviews:

• Primaquine for reducing plasmodium falciparum transmission  (Graves P, Gelband H) Link to review

In this new review, Patricia Graves and co-authors asess whether a single dose or short course of primaquine, added to standard treatments for Plasmodium falciparum malaria, reduces malaria transmission and is safe. Primaquine does not cure the infection but kills P. falciparum gametocytes, and is recommended by the WHO and several national malaria control programs, for reducing malaria transmission in the community. However, primaquine also has potentially serious side effects in people with G6PD deficiency, where it may cause haemolysis.  The review includes 11 RCTs with a total of 1776 individuals. None of the trials assessed effects on malaria transmission, and only one small study suggested it reduces the infectiousness of the parasite present in infected people to the mosquito. The trials do not provide enough evidence about safety. In conclusion, the findings of this review do not support using primaquine to reduce malaria.

• Antipyretic measures for treating fever in malaria (Meremikwu MM, Odigwe CC, Akudo Nwagbara B, Udoh E) Link to review

This review, first published in 2000, has been updated by Martin Meremikwu and his new team of authors. Seven new studies have been added and the review now includes 10 RCTs with 990 participants (both adults and children), mostly patients with uncomplicated P. falciparum malaria. All studies were small and had variable methodological quality.  Antipyretics measures assessed in the review include drugs such as paracetamol, ibuprofen and other nonsteroidal anti-inflammmatory drugs , and physical methods such as tepid sponging, fanning, and cooling blankets.  The results show variable effects of antipyretics measures on fever clearance time, and no clear effect on parasite clearance. There were no differences in the number or severity of adverse events between patients receiving antipyretic drugs and controls. The authors conclude that fever management in malaria with antipyretics remains a common practice, and there is insufficient evidence to recommend changing it, but more data on drugs safety and on patients’ preferences is needed.

New protocols

• Therapeutic and prophylactic drug interventions for Schistosomiasis japonicum (Alejandria MM, Roman AD, Gonzales MLM, Amarillo ML, Belizario VY, Qin L) Link to protocol

2012, Issue 7

One updated review and two new protocols  are  available in Issue 7, 2012 of the Cochrane Database of Systematic Reviews:

• Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin and school performance (Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P) Link to review

The World Health Organization (WHO) recommends treating all school children at regular intervals with deworming drugs in areas where helminth infection is common, to improve nutritional status, overal health, and school attendance, and consequently attain reductions in child mortality and higher economic productivity.  This review, first published in 2007 and now updated by David Taylor-Robinson and co-authors, wants to determine whether the benefits attributed to the use of deworming drugs are based on reliable evidence.  The review now includes 42 trials, including eight cluster trials, with 65,168 participants. Routine deworming drugs given to school children did not show benefit on weight in most studies, except in three older trials. For haemoglobin, community deworming seemed to have little or no effect, and the evidence in relation to cognition, school attendance, and school performance was generally poor, with no obvious or consistent effect. There was no pattern of effect in relation to areas of low, medium and high helminth endemicity.  The authors conclude that it is probably misleading to justify contemporary deworming programmes based on evidence of consistent benefit on nutrition, haemoglobin, school attendance or school performance as there is insufficient reliable information to know whether this is so.

New protocols

• Fixed-dose combinations of drugs versus single drug formulations for treating pulmonary tuberculosis (Gallardo CR, Rigau Comas D, Valderrama Rodriguez A, Roque i Figuls M, Parker LA, Cayla J, Bonfill Cosp X) Link to protocol
• Pre-referral rectal artesunate for severe malaria (Norrie J, Okebe JU, Eisenhut M) Link to protocol

2012, Issue 6

Two updated reviews are  available in Issue 6, 2012 of the Cochrane Database of Systematic Reviews:

• Artesunate versus quinine for treating severe malaria (Sinclair D, Donegan S, Isba R, Lalloo DG) Link to review

This review, first published in 2007, has now been updated and a new author, Rachel Isba, has added an economic evaluation to the clinical results. The review includes 8 trials involving a total of 1664 adults and 5765 children, from a variety of settings across Africa and Asia.  The results show that treating adults in Asia with artesunate instead of quinine would prevent an extra 94 deaths for every 1000 patients treated. In trials involving children, the proportion of deaths was lower than in the trials involving adults. This lower risk of death results in a smaller benefit in children than in adults, but would still save an extra 26 lives for every 1000 children treated.  Although more children given artesunate suffered neurological problems compared to those given quinine, these were largely resolved within a month of treatment, and were outweighed by the increase in survival rates.  In conclusion, artesunate should be the drug of choice for adults and children with severe malaria worldwide. Two cost-effectiveness studies were also included, indicating that, from an economic perspective, the use of artesunate for the treatment of severe malaria is a promising strategy when compared with quinine.

• Oral zinc for treating diarrhoea in children (Lazzerini M, Ronfani L) Link to review

Marzia Lazzerini and her coauthors have updated this review, first published in 2008.  The review now includes twenty-four trials, enrolling 9128 children of all ages suffering from diarrhea , who received oral zinc supplements or placebo . The majority of the data is from Asia, from countries at high risk of zinc deficiency, and may not be applicable elsewhere. The results demonstrate that zinc is clearly of benefit in children aged six months or more, as it reduces the duration of symptoms of acute diarrhoea. This benefit is evident irrespective of nutritional status, geographic region, study setting and other characteristics. Zinc is also useful in reducing the duration of persistent diarrhoea, but does not seem to have an impact in children aged less than six months.

Zinc administration can induce vomit (because of a metallic aftertaste), but development of a more palatable formulation may minimize this problem. The results of this review support the current WHO/UNICEF policy to give zinc to children with diarrhoea.

2012, Issue 5

One new review is available in Issue 5, 2012 of the Cochrane Database of Systematic Reviews:

• Patient education and counselling for promoting adherence to treatment for tuberculosis (M'Imunya JM, Kredo T, Volmink J) ) Link to review

Tuberculosis (TB) patients do not always take their medication as prescribed.  There are many possible reasons for this lack of adherence.  TB treatment requires several drugs to be taken regularly for six to twelve months, and many patients find it difficult to follow such a difficult and prolonged schedule, or perhaps feel better after the first few months of treatment, and stop taking medication. Other patients stop because of drug side effects, social and economic factors such as stigma or lack of family support, and invonvenient treatment arrangements or non-availability of drugs in the health clinics.
A team, led by James Machoki M'Imunya, has completed this review which examines whether providing patients with information or one-to-one or group counselling about TB and the need to complete treatment, may enhance patient adherence. The authors identified only 3 trials (including 1437 participants), run in the USA and Spain, all of low methodological quality.  Two of these studies demonstrated a beneficial effect of education and counselling for promoting adherence to treatment for latent TB, whereas one did not..  The trials were quite different with respect to populations targeted, interventions chosen and outcomes measured, and none of them assessed the effect on treatment for active TB.  In conclusion, there was not enough evidence to draw firm conclusions on the usefulness of education and counselling for TB treatment adherence.

2012, Issue 2

Three updated reviews and two new protocols are available in Issue 2, 2012 of the Cochrane Database of Systematic Reviews:

• Intermittent preventive treatment for malaria in children living in areas with seasonal transmission (Meremikwu MM, Donegan S, Esu E, Oringanje C) Link to review

Martin Meremikwu and co-authors have split the original review (published in 2005) into two separate ones: this one and "Intermittent preventive treatment in infants". This updated review focuses on the potential benefit and harm of giving intermittent preventive treatment (IPTc) to all children up to five years of age who live in areas with seasonal malaria transmission, regardless of whether they are infected or not, and excluding trials on continuous prophylaxis.

The review includes 7 trials with 12,589 participants, all conducted in West Africa. IPTc was shown to prevent three quarters of all malaria episodes, including severe ones, and also to prevent some deaths. This benefit occurred even in areas where insecticide treated net usage was high. Different antimalarial drugs or combinations are used for IPT but the most studied is amodiaquine plus sulphadoxine-pyrimethamine (AQ+SP) - this combination does not show serious side effects but can cause vomiting in some children.

• Vacines for preventing rotavirus diarrhoea: vaccines in use (Soares-Weiser K, MacLehose H, Bergman H, Ben-Aharon I, Nagpal S, Goldberg E, Pitan F, Cunliffe N) Link to review

Rotavirus infection causes more diarrhoea-related deaths in children less than five years of age than any other single agent in low-and middle-income countries, and is also a common cause of hospital admissions in high-income countries. Since 2009, the World Health Organization (WHO) has recommended that all children should be immunized against rotavirus with one of the vaccines approved for use (RV1, RV5, and LLR). Karla Soares-Weiser and her team in this review analyse data from 43 trials with 190,551 participants. Thirty-one trials assessed RV1, and 12 trials evaluated RV5; all trials compared a rotavirus vaccine with placebo. No trials assessing LLR were identified. Compared to placebo, RV1 probably prevents 70% of all cases of rotavirus diarrhoea, and 80% or severe episodes during the first and second year of life. RV5 reduced any rotavirus diarrhoea or severe cases by more than 70% in the first year, and by approximately 50% in the second year. Reported serious adverse events (including intussusception) after vaccination were measured in 95,178 children for RV1 and 77,480 for RV5, with no difference between the vaccines. In conclusion, data from this review shows that rotavirus vaccines are effective in preventing rotavirus diarrhoea, and support the WHO's global vaccine recommendations. Continued safety monitoring is advised in countries where vaccines are routinely used.

• Vaccines for preventing plague (Jefferson T, Demicheli V, Pratt M )Link to review

The objective of this review, first published by Thomas Jefferson in 1998, is to assess the effects of vaccines to prevent plague. Plague is a serious bacterial disease transmitted by fleas and related to rat infestation, that can lead to blood poisoning and to death. Although rare nowadays, plague is still endemic in many regions of the world. There are three types of plague vaccines (live attenuated, killed and F1 fraction) with different means of administration. These vaccines are available for use in laboratory staff working on the disease. No randomized trials of plague vaccines have been identified for inclusion in this review. Data from observational studies suggest that killed vaccines may be more effective and have fewer adverse effects than attenuated types of vaccine. No evidence appears to exist on the long-term effects of any plague vaccine. New protocols

• Fluid resuscitation for children with severe febrile illness and septic shock in resource-limited settings (von Saint Andre A, Pavinac PB, Jacob ST, Zimmerman J, Watson JL) Link to protoco
• Rapid screening and diagnostic tests for human schistosomiasis in endemic areas (Ochodo EA, Spek B, Reitsma JB, Van Lieshout L, Polman K, Lamberton P, Bossuyt PMM, Leeflang MM) Link to protocol

2012, Issue 1

New review

• Material incentives and enablers in the management of tuberculosis (Lutge EE, Wiysonge CS, Knight SE, Volmink Link to review

Tuberculosis (TB) patients do not always return to hospital or to health centers to take prescribed treatments and for the results of their tests. One possible cause for this lack of adherence to their appointments is that TB treatment requires medication to be taken regularly for six to twelve months, and many patients find it difficult to follow such a difficult and prolonged schedule.
A South African author team, led by Elizabeth Lutge, has completed this review of 11 studies looking at how material incentives (such as cash, vouchers or tokens) may encourage TB patients to adhere to their scheduled medical appointments. Incentives appear to increase the number of patients who return to the clinic to receive their test results for the diagnosis fo tuberculosis, and those who go to the clinic to start treatment, but do not increase the number of patients who complete treatment. The trials currently included in the review were run among male drug users, homeless, and prisoner subpopulations in the USA, and therefore, the results are not easily generalised to the wider adult population, or to low-and middle -income countries.

New protocols

• Combined and alternating paracetamol and ibuprofen therapy for fever in children (Wong T, Stang AS, Ganshom H, Maconochie IK, Hartling L, Johnson DW) Link to protocol
• Paediatric formulations of artemisinin-combination therapies for treating uncomplicated malaria in children (Belard S, Kurth F, Ramharter M) Link to protocol
• Xpert MTB/RIF test for detection of pulmonary tuberculosis and refampicin resistance (Sohn H, Pai M, Dendukuri N, Kloda LA, Boehme CC, Steingart KR) Link to protocol