2019 Issue  12

Three new reviews are available in Issue 12 of the Cochrane Database of Systematic Reviews·

race AG, Mittal A, Jain S, Tripathy JP, Satyanarayana S, Tharyan P, Kirubakaran R. Shortened treatment regimens versus the standard regimen for drug‐sensitive pulmonary tuberculosis. Cochrane Database of Systematic Reviews 2019, Issue 12. Art. No.: CD012918. DOI: 10.1002/14651858.CD012918.pub2

This new review by Angeline Grace and her colleagues, examines whether the duration of anti‐tuberculosis treatment (ATT) for people with newly diagnosed drug‐sensitive pulmonary tuberculosis can be shortened to less than six months. Current treatment is a six‐month combination of drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide for two months, followed by isoniazid and rifampicin with or without ethambutol for four months); many people do not complete the treatment because of the long duration, or because of drug side effects, but incomplete or irregular treatment can lead to treatment failure and can increase disease relapse. The review includes 5 randomized trials comparing fluoroquinolone‐containing four‐month ATT regimens versus standard six‐month ATT regimens, and recruited 5825 adults with newly diagnosed drug‐sensitive pulmonary tuberculosis from 14 countries with high tuberculosis transmission in Asia, Africa, and Latin America. Three trials included 572 HIV‐positive people, but all trial excluded people with other serious comorbidities. Although treatment success and serious adverse events were little or no different between the 4-months’ and the 6 months’ regimens, the shortened regimens appeared to increase relapse, and the authors conclude that evidence to date does not support the use of shortened ATT regimens in adults with newly diagnosed drug‐sensitive pulmonary tuberculosis. 

Liang  Y, Zhang  L, Zeng  L, Gordon  M, Wen  J. Racecadotril for acute diarrhoea in children. Cochrane Database of Systematic Reviews 2019, Issue 12. Art. No.: CD009359. DOI: 10.1002/14651858.CD009359.pub2

Racecadotril is an anti‐secretory drug that has been used for acute diarrhoea in children as an adjunct to oral rehydration therapy. This new review by Yi Liang and colleagues assessed the efficacy and safety of racecadotril for treating acute diarrhoea in children under five years of age, in comparison with placebo or no treatment. Seven RCTs with a total of 1140 participants met the inclusion criteria; trials were carried out on children aged three months to five years, in outpatient and inpatient facilities from France, Spain, Peru, India, Kenya, and Ecuador. Racecadotril may reduce the risk of rehydration failure, but the data is of low certainty evidence. Data on duration of diarrhoea and number of stools in the first 48 hours were insufficient to reach a conclusion. Length of hospital stay was similar in two studies measuring this, and overall there was no evidence that racecadotril increased overall rate of adverse events. The author conclude that current evidence does not support routine use of racecadotril in management of acute diarrhoea in children under five, outside of the context of placebo‐controlled RCTs.

Esu  EB, Oringanje  C, Meremikwu  MM. Intermittent preventive treatment for malaria in infants. Cochrane Database of Systematic Reviews 2019, Issue 12. Art. No.: CD011525. DOI: 10.1002/14651858.CD011525.pub2

2019 Issue 11

No publications produced for Issue 11

2019 issue 10

Two review updates and one new protocol are available in Issue 10 of the Cochrane Database of Systematic Reviews

Updated Reviews

Bjerrum S, Schiller I, Dendukuri N, Kohli M, Nathavitharana RR, Zwerling AA, Denkinger CM, Steingart KR, Shah M. Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in people living with HIV. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD011420. DOI: 10.1002/14651858.CD011420.pub3.

This is an update of the 2016 Cochrane review with the same title; there have been some changes in the author team and some technical details.  LF‐LAM is a commercially available point‐of‐care test that detects lipoarabinomannan (LAM), a component of the bacterial cell walls, present in some people with active tuberculosis. The test is simple and shows results in 25 minutes. This review examines the accuracy of LF‐LAM for the diagnosis of active tuberculosis among HIV‐positive adults with signs and symptoms of tuberculosis and among HIV‐positive adults irrespective of signs and symptoms of tuberculosis, and is part of the WHO process for updating guidance on the use of LF‐LAM. Stephanie Bjerrum and colleagues have identified 9 new studies for a total of 15 included studies, all conducted in low‐ or middle‐income countries. LF‐LAM showed s a sensitivity of 42% to diagnose tuberculosis in HIV‐positive individuals with tuberculosis symptoms and 35% in HIV‐positive individuals not assessed for tuberculosis symptoms, consistent with findings reported previously. Regardless of how people are enrolled, sensitivity is higher in inpatients and those with lower CD4 cells.  The authors conclude that as a simple point‐of‐care test that does not depend upon sputum evaluation, LF‐LAM may assist with the diagnosis of tuberculosis, particularly when a sputum specimen cannot be produced.

SoaresWeiser K, Bergman H, Henschke N, Pitan F, Cunliffe N. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD008521. DOI: 10.1002/14651858.CD008521.pub5.

This is an update This is an amendment to the review update published in March 2019 (Soares-Weiser 2019), in response to some comments received. Although a new citation is required, the included studies and conclusions have not changed since the review version published in March 2019.

New protocol

Jullien S, Dissanayake HA, Chaplin M. Rapid diagnostic tests for plague. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD013459. DOI: 10.1002/14651858.CD013459.

2019 Issue 9

Two new reviews and one updated review are available in Issue 9 of the Cochrane Database of Systematic Reviews

New Reviews

Majorin F, Torondel B, Ka Seen Chan G, Clasen T. Interventions to improve disposal of child faeces for preventing diarrhoea and soil‐transmitted helminth infection. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD011055. DOI: 10.1002/14651858.CD011055.pub2.

This new review, prepared by Fiona Majorin and colleagues, examines the impact of improved disposal of child faeces on diarrhoea and soil‐transmitted helminth infections. Sanitation interventions have been shown to be effective in preventing diarrhoea and STH infections overall, but there has not been much focus on interventions on the disposal of child faeces. The authors of this review argue that the unsafe disposal of child faeces may represent a more important health risk to children, caregivers, and other community members than faeces of adults, because young children have the highest incidence of enteric infections, and their faeces are most likely to contain infectious agents. The review includes 63 studies covering over 222,800 participants, with different types of interventions, such as education and hygiene promotion, community programmes to end open defecation, provision of hardware such as nappies, potties, faecal collection devices, cleaning products, child‐friendly latrines. Most study sites (56/69) were in low‐ or lower middle‐income settings. There was some evidence that interventions to promote safe disposal of child faeces were protective against diarrhoea, but this evidence was of very low to moderate quality. There was no evidence that such interventions were protective against STH infections, but the evidence was very limited and the certainty was low to very low. 

Van Hoving DJ, Griesel R, Meintjes G, Takwoingi Y, Maartens G, Ochodo EA. Abdominal ultrasound for diagnosing abdominal tuberculosis or disseminated tuberculosis with abdominal involvement in HIV‐positive individuals. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012777. DOI: 10.1002/14651858.CD012777.pub2..  

This review investigates the accuracy of an ultrasound examination of the abdomen for diagnosing tuberculosis, in people with HIV suspected of having tuberculosis in the abdomen or widespread tuberculosis (disseminated tuberculosis) involving the abdomen. People living with HIV have a higher probability of developing tuberculosis, and extrapulmonary tuberculosis accounts for up to 50% of all tuberculosis cases in HIV+ people; however, detection rates are only an estimated 61% ,  reflecting a mixture of under‐reporting of detected cases and underdiagnosis of tuberculosis. Daniel Van Hoving and colleagues in this new review identified 11 studies for inclusion, but only six of these were relevant for the main analyses, and these were done in Cambodia, India, South Africa, South Sudan, Spain, and Tanzania. The analysis showed that in HIV+ people  thought to have abdominal tuberculosis or disseminated tuberculosis with abdominal involvement, abdominal ultrasound appears to have 63% sensitivity and 68% specificity when tuberculosis was bacteriologically confirmed. Quality of these studies was low. The low sensitivity of abdominal ultrasound means clinicians should not use a negative test result to rule out the disease, but rather consider the result in combination with other diagnostic strategies (including clinical signs, chest x‐ray, lateral flow urine lipoarabinomannan assay (LF‐LAM), and Xpert MTB/RIF).

Updated Review

TaylorRobinson DC, Maayan N, Donegan S, Chaplin M, Garner P. Public health deworming programmes for soil‐transmitted helminths in children living in endemic areas. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD000371. DOI: 10.1002/14651858.CD000371.pub7. 

The World Health Organization (WHO) recommends treating all school children at regular intervals with deworming drugs in areas where helminth infection is common, and global advocacy organizations claim routine deworming has substantive health and societal effects beyond the removal of worms. In this updated review, David Taylor‐Robinson and his team summarize the effects of public health deworming programmes on child growth, haemoglobin, cognition, school attendance, school performance, physical fitness, and mortality. This review has a long history as it was first published in 1998, and the title and methods have been changed through time. This last version follows a prespecified update plan, approved by two CIDG Editor before starting the update, and it includes six new trials. The review now includes 51 trials, (with 10 cluster‐RCTs; one trial evaluating mortality included over one million children, and the remaining 50 trials included a total of 84,336 participants. In populations of children living in endemic areas, deworming showed little or no effect on weight gain in most studies, except for 2 older studies (one in Kenya and one in India) in children heavily infected with worms. In trials from 2000 onwards, which are more relevant given the global reduction in worm burden, there was little or no effect. Overall, there was also substantial evidence of no benefit in terms of haemoglobin, cognition, school performance, and mortality. The authors suggest that the current evidence does not support large public health programmes of deworming in low and middle‐income countries.

2019 Issue 8

Two new reviews and two new protocols are available in Issue 8 of the  Cochrane Database of Systematic Reviews

New Reviews

Choi  L, Majambere  S, Wilson  AL. Larviciding to prevent malaria transmission. Cochrane Database of Systematic Reviews 2019, Issue 8. Art. No.: CD012736. DOI: 10.1002/14651858.CD012736.pub2.

Larviciding refers to the application of microbial or chemical insecticides to water bodies or water containers, with the aim of killing mosquito larvae so that fewer will develop into adults. This should reduce the number of mosquitoes that bite and infect humans with malaria. There are several different types of larvicide, such as chemical larvicides (conventional insecticides or insect growth regulators), microbial larvicides (such as Bacillus thuringiensis israeliensis and Bacillus sphaericus ) and oils. Leslie Choi, Silas Majambere and Anne Wilson have completed this new review, that compared larviciding with no larviciding. Four studies (one RCT, two controlled before‐and‐after studies ,  and one non‐randomized cross‐over design) met the inclusion criteria. All used ground application of larvicides (people hand‐delivering larvicides); one evaluated chemical and three evaluated microbial agents. Studies were carried out in The Gambia, Tanzania, Kenya, and Sri Lanka. The authors found no studies using larviciding application techniques that could cover large aquatic habitats, such as aerial spraying using aircraft. The conclusion from the included studies is that larviciding may decrease at least one malaria disease outcome in areas where the mosquito aquatic habitats were less than 1 square km (low‐certainty evidence). The WHO currently recommends larviciding and other larval source management (LSM) interventions as a supplementary malaria control intervention, so that further evidence on the effects of larviciding should be generated through monitoring and evaluation of programmatic implementation.

Braganza Menezes  D, Menezes  B, Dedicoat  M. Contact tracing strategies in household and congregate environments to identify cases of tuberculosis in low‐ and moderate‐incidence populations. Cochrane Database of Systematic Reviews 2019, Issue 8. Art. No.: CD013077. DOI: 10.1002/14651858.CD013077.pub2.

This new review by Darryl Braganza Menezes and colleagues aims to analyze the evidence supporting the current approach to contact tracing (the process of identifying individuals exposed to an infectious case of tuberculosis), and whether alternate options could result in a higher rate of infection detection in TB contacts. The currently adopted approach for contact tracing utilizes a ‘stone‐in‐pond’ model; each ‘ripple’ represents a social circle, with varying degrees of physical proximity to the index case, and screening progresses to the next possible circle of contacts only if a predefined proportion of positive contacts are found in the previous circle. Alternative approaches for contact tracing consider not only the list of contacts volunteered by the patient, but also other social relationships and opportunistic contacts, such as work colleagues, and people met for example in bars, shops, and transport. The reviewers aimed to include RCTs and cluster RCTs of contact tracing, run in areas of low and moderate TB incidence. However, no trials for inclusion were identified, and the authors conclude that this highlights the lack of research in support of the current contact tracing method and the need for RCTs to compare new methods such as social network analysis. 

New Protocols

Furnival‐Adams  J, Olanga  EA, Napier  M, Garner  P. Housing interventions for preventing malaria. Cochrane Database of Systematic Reviews 2019, Issue 8. Art. No.: CD013398. DOI: 10.1002/14651858.CD013398

Obonyo CO, Muok EMO, Were V. Biannual praziquantel treatment for schistosomiasis. Cochrane Database of Systematic Reviews 2019, Issue 8. Art. No.: CD013412. DOI: 10.1002/14651858.CD013412

2019 Issue 7

One new review is available in Issue 7 of the Cochrane Database of Systematic Reviews

New Review

Milligan  R, Daher  A, Graves  PM. Primaquine at alternative dosing schedules for preventing relapse in people with   Plasmodium vivax malaria. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD012656. DOI: 10.1002/14651858.CD012656.pub2.

Rachael Milligan, André Daher and Patricia Graves are the authors of this new review, which summarizes data from trials comparing the World Health Organization (WHO)‐recommended primaquine regimen of 15 to 30 mg per day for 14 days with the same or higher doses of primaquine given over different lengths of time, to determine whether alternative regimens were as successful as the recommended courses at preventing future episodes of P vivax malaria. The WHO recommended 14-day drug course can be difficult to complete, and primaquine can cause dangerous haemolysis in individuals with glucose‐6‐phosphate dehydrogenase (G6PD) deficiency, which is a relatively common genetic blood disorder. Shorter regimens would help reduce the risk of default with the current two‐week regimen. The review includes 9 trials conducted in South America and in Asia; all trials included data for adults, and four trials included children under the age of 10 years, but no trials had information on children under one year old. Although limited data were available, the analysis did not detect a difference in recurrence between the 7‐day regimen and the standard 14‐day regimen of 0.5 mg/kg/day primaquine, and no serious adverse events were reported in G6PD‐normal participants taking 0.5 mg/kg/day of primaquine. The authors recommend that further large high‐quality RCTs are needed, with more standardised comparison regimens and longer follow‐up, to help resolve uncertainties.

2019 Issue 6

One new  protocol, one new review and two review updates are available in Issue 6 of the Cochrane Database of Systematic Reviews

New Protocol

Kay AW, Gonzales Fernandez L, Takwoingi Y, Eisenhut M, Vu RD, Steingart KR, Detjen AK, Mandalakas AM.  Expert MTB/RIF and Xpert MTB/RIF Ultra assays for active tuberculosis and rifampicin resistance in children. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD013359. DOI: 10.1002/14651858.CD013359.

New Review

Mateo-Urdiales A, Johnson S, Smith R, Nachega JB, Eshun-Wilson I, Rapid initiation of antiretroviral therapy for people living with HIV. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No. CDO12962. DOI: 10.1002/14651858.CD012962.pub2

Alberto Mateo‐Urdiales and his team in this new review evaluate whether rapid anti-retroviral therapy (ART) initiation, i.e. starting ART as soon as possible after testing HIV‐positive, normally within seven days, improves treatment outcomes and mortality in people living with HIV (PLWH). In 2017, only 59% of PLWH were receiving ART, with high attrition from HIV services after HIV diagnosis; this is particularly relevant in sub‐Saharan Africa. Even when PLWH receive ART, they may wait over a month to start therapy, once eligibility is established; the reasons for these delays are complex and involve a combination of structural, social, and psychological patient factors, as well as poor healthcare infrastructure in some settings. The authors identified 7 RCTs with 18,011 participants for inclusion in the review. All studies were carried out in low‐ and middle‐income countries in adults aged 18 years old or older; only one RCT included pregnant women. Most studies conducted some assessment of ‘readiness to start ART', through counselling sessions or a checklist, and rapid ART initiation was frequently delivered alongside other interventions targeted at modifying individual or health workers' behaviours, such as reminders, incentives, or expedited drug dispensing, as well as training for   healthcare workers. The reviewers fund that rapid ART probably increases the number of people being initiated on ART at 12 months and the number of PLWH with no detectable virus in their blood at 12 months, and it may increase the number of PLWH being retained in care. It is not clear whether rapid ART has an effect on the number of deaths.  Several changes need to be made to health system structures and processes in order to benefit from rapid ART initiation. 

Updated  Reviews

Esu  EB, Effa  EE, Opie  ON, Meremikwu  MM. Artemether for severe malaria. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD010678. DOI: 10.1002/14651858.CD010678.pub3.

This review, first published in 2014 and now updated by Ekpereonne Esu and colleagues from Nigeria, aims to assess the efficacy and safety of intramuscular artemether versus any other parenteral medication in the treatment of severe malaria in adults and children. Artemether is an artemisinin‐based medicine only available as a pre‐mixed oil‐based solution for intramuscular injection; it is now widely available and is used in many African countries, although it is not specifically recommended by the WHO.  The authors identified one new study and the updated review includes 19 RCTs, enrolling 2874 adults and children with severe malaria, carried out in Africa (12 trials) and in Asia (7 trials). In comparison with quinine, artemether did not seem more effective at preventing deaths from severe malaria in children, but it was more effective at preventing deaths in adults, and it also seemed more effective at improving other patient‐oriented outcomes such as fever and parasite clearance time, in both children and adults. In comparison with artesunate, artemether performs worse in terms of mortality in adults; no trials comparing artesunate with artemether have been conducted in young children.  The authors conclude that artemether is probably less effective than artesunate at preventing deaths from severe malaria, but where artesunate is not available, artemether is an alternative to quinine.

Horne  DJ, Kohli  M, Zifodya  JS, Schiller  I, Dendukuri  N, Tollefson  D, Schumacher  SG, Ochodo  EA, Pai  M, Steingart  KR. Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD009593. DOI: 10.1002/14651858.CD009593.pub4.

Karen Steingart and colleagues have updated this review which assesses the diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for tuberculosis in adults with presumptive pulmonary tuberculosis (PTB), and for rifampicin resistance in adults with presumptive rifampicin‐resistant tuberculosis. Xpert MTB/RIF and Xpert Ultra, the newest version, are World Health Organization‐recommended tests that simultaneously detect tuberculosis and rifampicin resistance in persons with tuberculosis symptoms. Rifampicin is an important anti‐tuberculosis drug. Not recognizing tuberculosis early may result in delayed diagnosis and treatment, severe illness, and death. The review authors identified 95 unique studies, integrating 77 new studies since publication of the previous Cochrane Review (Steingart 2014). 86 studies (42,091 participants) evaluated Xpert MTB/RIF for tuberculosis and 57 studies (8287 participants) for rifampicin resistance. One study compared Xpert MTB/RIF and Xpert Ultra on the same participant specimen. Xpert MTB/RIF was found to be sensitive and specific for diagnosing PTB and rifampicin resistance, consistent with findings reported previously. Xpert MTB/RIF was more sensitive for tuberculosis in smear‐positive than smear‐negative participants and HIV‐negative than HIV‐positive participants. Compared with Xpert MTB/RIF, Xpert Ultra had higher sensitivity and lower specificity for tuberculosis and similar sensitivity and specificity for rifampicin resistance. Future studies should assess the diagnostic accuracy of Xpert Ultra compared with other rapid tests for tuberculosis and drug resistance, especially in difficult‐to‐diagnose groups, such as children, people living with HIV, and those with extrapulmonary tuberculosis.

2019 Issue 5

One new review and one new protocol are  available in Issue 5 of the Cochrane Database of Systematic Reviews

New Review

Choi  L, Pryce  J, Garner  P. Indoor residual spraying for preventing malaria in communities using insecticide‐treated nets. Cochrane Database of Systematic Reviews 2019, Issue 5. Art. No.: CD012688. DOI: 10.1002/14651858.CD012688.pub2.

This new review, prepared by the LSTM-based team of Leslie Choi, Joseph Pryce and Paul Garner, summarizes the effect on malaria of adding indoor residual spraying (IRS), using non‐pyrethroid‐like or pyrethroid‐like insecticides, in communities currently using insecticide‐treated nets (ITNs). Adding IRS to ITNs may improve control, simply because two interventions may be better than one; it may improve malaria control where ITNs are failing due to pyrethroid resistance; and it may slow the emergence and spread of pyrethroid resistance. Six cluster randomized trials with 8 comparisons met the inclusion criteria. Adding IRS with a non‐pyrethroid‐like insecticide had mixed results: it is not clear if the addition of IRS impacted on malaria incidence, but it may have reduced malaria parasite and the prevalence of anaemia. Adding IRS using a pyrethroid‐like insecticide did not appear to markedly alter malaria incidence, parasite prevalence, or anaemia prevalence. Given the wide geographical variety of malaria endemicities, transmission patterns, and insecticide resistance, it is not possible to draw precise conclusions from the limited number of trials conducted to date. 

New Protocol

Bauza  V, Sclar  G, Majorin  F, Clasen  T. Interventions to improve sanitation for preventing diarrhoea. Cochrane Database of Systematic Reviews 2019, Issue 5. Art. No.: CD013328. DOI: 10.1002/14651858.CD013328.

2019 Issue 4

One new review is available in Issue 4 of the Cochrane Database of Systematic Reviews

New Review

Kashangura  R, Jullien  S, Garner  P, Johnson  S. MVA85A vaccine to enhance BCG for preventing tuberculosis. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD012915. DOI: 10.1002/14651858.CD012915.pub2.

Rufaro Kashangura, Sophie Jullien, Paul Garner and Samuel Johnson are the authors of this new review that aims to assess and summarize the effects of the MVA85A vaccine boosting BCG in humans. Bacillus Calmette‐Guérin (BCG) is the only available vaccine against tuberculosis, but protection is incomplete and variable. The modified Vaccinia Ankara virus expressing antigen 85A (MVA85A) is a viral vector vaccine produced to prevent tuberculosis. Immunological studies showed that a prime boost strategy, where MVA85A was used to boost the effects of BCG, was effective in expanding immune responses specific to M tuberculosis. MVA85A was tested In Phase 1 studies in humans, and this review presents a summary of safety data from 21 studies with 712 participants, which showed most of the adverse effects related to vaccination were mild and were contained locally to the injection site, and only very few serious adverse effects. The review also presents data from 6 studies (3838 participants) that reported findings from four Phase 2 clinical trials. All trials took place in South Africa and one trial also had a site in Senegal. Five studies included infants, one of them infants born to HIV‐positive mothers, and one study included adults living with HIV. MVA85A added to BCG compared to BCG alone had no effect on the risk of developing microbiologically confirmed tuberculosis, latent tuberculosis, or the risk of starting on tuberculosis treatment. The authors concluded that MVA85A delivered by intradermal injection in addition to BCG is safe but not effective in reducing the risk of developing tuberculosis

2019 Issue 3

One new protocol, one new review and one updated review are  available in Issue 3  of the   Cochrane Database of Systematic Reviews

New Protocol

Choi L, McIntyre S,Furnival-Adams J, Indoor residual spraying for preventing malaria. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD013300. DOI: 10.1002/14651858.CD01330 

New Review

Singh B, Cocker D, Ryan H, Sloan DJ, Linezolid for drug-resistant pulmonary tuberculosis. Cochrane Database of Systematic Reviews 2019, Issue 3. Art No.: CD012836. DOI: 10.1002/14651858.CD01.2836.pub2.

This new review, authored by Bhagteshwar Singh and colleagues in Liverpool, examines the efficacy and safety of linezolid when used as part of a second‐line regimen for treating people with multi‐drug resistant tuberculosis (MDR‐TB) and extensively drug‐resistant tuberculosis (XDR‐TB).  Linezolid was recently re‐classified as a Group A (“Medicines to be prioritised”) drug by the World Health Organization (WHO) for treatment of MDR‐TB and XDR‐TB, suggesting that it should be included in the regimen for all patients unless contraindicated, but it also carries a considerable risk of toxicity, with the optimal dose and duration remaining unclear. This review included randomized controlled trials to evaluate efficacy outcomes, and non‐randomized cohort studies to evaluate adverse events. The authors identified 3 RCTs for inclusion (one of poor quality and 2 small ones), and 14 non‐randomized cohort studies (two prospective, 12 retrospective), with a total of 1678 participants for safety outcomes. The 2 small RCTs, both conducted in people with XDR‐TB, reported better efficacy outcomes with linezolid use. Regarding safety outcomes, the first trial found a higher risk of developing low red blood cell counts, nausea and vomiting, and nerve damage in people receiving linezolid. In 11 of the non‐randomized studies, 22.6% of people had to stop linezolid due to adverse effects, but further comparisons of harmful effects were not possible due to incomplete reporting in these studies.

Updated  Review

Soares‐Weiser  K, Bergman  H, Henschke  N, Pitan  F, Cunliffe  N. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD008521. DOI: 10.1002/14651858.CD008521.pub4.

This is the fourth update of the original rotavirus vaccines review (Soares‐Weiser 2004), and it assesses efficacy and safety of the vaccines prequalified for use by the WHO: RV1, RV5, and Rotavac. The author team, led by Karla Soares-Weiser, identified 55 trials with a total of 216,480 participants for inclusion (36 trials with 119,114 participants assessed RV1, 15 trials (88,934 participants) RV5, and 4 trials (8432 participants) Rotavac. Results were stratified by child age (infants or children up to two years), and by countries with high or low child mortality. RV1, RV5, and Rotavac were all found to prevent episodes of rotavirus diarrhoea; the relative effect estimate was smaller in high‐mortality than in low‐mortality countries, but there is a greater number of episodes prevented in these settings as the baseline risk is much higher. The data from the included RCTs excluded a risk of intussusception (or other serious adverse events) with RV1, RV5, and Rotavac, of the magnitude observed with the first licensed vaccine; however, the authors recommend that routine vaccine introduction should be accompanied by safety surveillance.  

2019 Issue 2

One new protocol is available in Issue 2  of the Cochrane Database of Systematic Reviews

New Protocol

Choi  L, Johnson  S, Cunningham  J, Takwoingi  Y. Rapid diagnostic tests for Plasmodium vivax malaria in endemic countries. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013218. DOI: 10.1002/14651858.CD013218.

2019 Issue 1

Three updated reviews are available in Issue 1 of the Cochrane Database of Systematic Reviews

Updated Reviews

Gonzales  MLM, Dans  LF, SioAguilar  J. Antiamoebic drugs for treating amoebic colitis Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD006085. DOI: 10.1002/14651858.CD006085.pub3 

This review was first published in 2009 and has now a new author in the team, still led by Maria Liza Gonzales.  The review evaluates effectiveness and safety of drugs used to treat people with amoebic colitis, which is an infection of the large intestines caused by the parasite, Entamoeba histolytica. The parasite is distributed throughout the world and is commonly acquired by ingestion of contaminated food or water. For this update, the authors added four trials to the 37 trials included in the first published review version. Thirty trials were published over 20 years ago; only one trial used adequate methods of randomization and allocation concealment. The review shows that tinidazole may be more effective than metronidazole for reducing clinical symptoms and may results in fewer adverse events. Combination therapy resulted in fewer parasitological failures than occurred with metronidazole alone. There is insufficient evidence to allow conclusions regarding the efficacy of other antiamoebic drugs. Better quality randomized trials using accurate diagnostic methods and standardized outcomes are needed. 

Pryce  J, Hine  P. Pyronaridine-artesunate for treating uncomplicated Plasmodium falciparum malariaCochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD006404. DOI: 10.1002/14651858.CD006404.pub3. Read the LSTM news article

This review is an update of a Cochrane Review first published in 2007 (Unnikrishnan 2007), and previously updated in 2014 (Bukirwa 2014). The updated review had a different name and the new authors (Joseph Pryce and Paul Hine) decided to use the term pyronaridine‐artesunate in preference to artesunate‐pyronaridine, to reflect how most authors currently refer to the intervention. The background section and methodology have also been modified.  Pyronaridine has been shown to have potent in vitro activity versus P falciparum; its combination with artesunate was first developed in 2002 and first registered in 2011, with the Korean Food and Drug Administration. This review update includes 10 trials (7 were co‐funded by Shin Poong Pharmaceuticals which manufactures the drug, and 3 were funded by government agencies). Pyronaridine-artesunate was compared to artemether‐lumefantrine, artesunate‐amodiaquine or to mefloquine plus artesunate, in adults and children. It was found to effectively treat uncomplicated P falciparum malaria, and to be as good or better than other artemisinin‐based combination therapies (ACTs), but it increases the risk of having blood tests which suggest mild liver injury. A pyronaridine‐artesunate hepatic safety study is ongoing.

Macfarlane  CL, Budhathoki  SS, Johnson  S, Richardson  M, Garner  P. Albendazole alone or in combination with microfilaricidal drugs for lymphatic filariasis. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD003753. DOI: 10.1002/14651858.CD003753.pub4.

Cara Macfarlane and co-authors have completely updated this review, which was last published in 2005. The review has new authors, a new title, all data has been re‐extracted, and newer methodology has been applied. The authors included 13 trials (12 individually‐randomized and one small cluster‐randomized trial) with 8713 participants in total, assessing the effects of albendazole alone, and the effects of adding albendazole to DEC or ivermectin, in people and communities with lymphatic filariasis. The results show good evidence that albendazole makes little difference to clearing microfilaraemia or adult filarial worms in the 12 months post‐treatment. This finding is consistent in trials evaluating albendazole alone, or added to DEC or ivermectin. Further research is needed to inform policy for areas where ivermectin and DEC cannot be given.