Efficacy of 5-Nitroimidazoles for the Treatment of Giardiasis: A Systematic Review of Randomized Controlled Trials

5.00
Hdl Handle:
http://hdl.handle.net/10757/316481
Title:
Efficacy of 5-Nitroimidazoles for the Treatment of Giardiasis: A Systematic Review of Randomized Controlled Trials
Authors:
Pasupuleti, Vinay; Escobedo, Angel Arturo; Deshpande, Abhishek; Thota, Priyaleela; Roman, Yuani; Hernández, Adrian V. ( 0000-0002-9999-4003 )
Citation:
PLoS Negl Trop Dis 8(3): e2733
Publisher:
Public Library of Science (PLoS)
Journal:
PLOS Neglected Tropical Diseases
Issue Date:
3-May-2014
URI:
http://hdl.handle.net/10757/316481
DOI:
10.1371/journal.pntd.0002733
Additional Links:
http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002733
Abstract:
Background: Giardiasis is one of the most common causes of diarrheal disease worldwide and 5-nitroimidazoles (5-NI) are the most commonly prescribed drugs for the treatment of giardiasis. We evaluated the efficacy of 5-nitroimidazoles (5-NI) in the treatment of giardiasis in a systematic review of randomized controlled trials (RCTs). Methodology/Principal Findings: We conducted a comprehensive literature search in PubMed-Medline, Scopus, Web of Science and Cochrane Library for RCTs evaluating the efficacy of 5-NI vs. control (placebo or active treatment) on parasitological cure in patients with parasitologically-demonstrated giardiasis. The search was performed in May 2013 with no language restriction by two authors independently. The efficacy outcome was parasitological cure, and harmful outcomes were abdominal pain, bitter or metallic taste, and headache. We included 30 RCTs (n = 3,930). There was a significant and slightly higher response rate with 5-NI in giardiasis treatment (RR 1.06, 95%CI 1.02–1.11, p = 0.005). There was high heterogeneity among studies (I2= 72%). The response rates for metronidazole, tinidazole and secnidazole were similar (RR 1.05, 95%CI 1.01–1.09, p = 0.01; RR 1.32 95%CI 1.10–1.59, p = 0.003; and RR 1.18 95%CI 0.93–1.449, p = 0.18, respectively). On subgroup analyses, the response rates did not vary substantially and high heterogeneity persisted (I2= 57%–80%). Harmful outcomes were uncommon, and 5-NIs were associated with lower risk of abdominal pain, and higher risk of both bitter or metallic taste and headache. Conclusions: Studies investigating the efficacy of 5-NI in giardiasis treatment are highly heterogeneous. 5-NIs have a slightly better efficacy and worse profile for mild harmful outcomes in the treatment of giardiasis in comparison to controls. Larger high quality RCTs are needed to further assess efficacy and safety profiles of 5-NI.
Type:
info:eu-repo/semantics/article
Rights:
info:eu-repo/semantics/openAccess
Language:
eng
EISSN:
1932-6203

Full metadata record

DC FieldValue Language
dc.contributor.authorPasupuleti, Vinayspa
dc.contributor.authorEscobedo, Angel Arturospa
dc.contributor.authorDeshpande, Abhishekspa
dc.contributor.authorThota, Priyaleelaspa
dc.contributor.authorRoman, Yuanispa
dc.contributor.authorHernández, Adrian V.spa
dc.date.accessioned2014-05-03T20:51:54Z-
dc.date.available2014-05-03T20:51:54Z-
dc.date.issued2014-05-03-
dc.identifier.citationPLoS Negl Trop Dis 8(3): e2733spa
dc.identifier.doi10.1371/journal.pntd.0002733-
dc.identifier.urihttp://hdl.handle.net/10757/316481-
dc.description.abstractBackground: Giardiasis is one of the most common causes of diarrheal disease worldwide and 5-nitroimidazoles (5-NI) are the most commonly prescribed drugs for the treatment of giardiasis. We evaluated the efficacy of 5-nitroimidazoles (5-NI) in the treatment of giardiasis in a systematic review of randomized controlled trials (RCTs). Methodology/Principal Findings: We conducted a comprehensive literature search in PubMed-Medline, Scopus, Web of Science and Cochrane Library for RCTs evaluating the efficacy of 5-NI vs. control (placebo or active treatment) on parasitological cure in patients with parasitologically-demonstrated giardiasis. The search was performed in May 2013 with no language restriction by two authors independently. The efficacy outcome was parasitological cure, and harmful outcomes were abdominal pain, bitter or metallic taste, and headache. We included 30 RCTs (n = 3,930). There was a significant and slightly higher response rate with 5-NI in giardiasis treatment (RR 1.06, 95%CI 1.02–1.11, p = 0.005). There was high heterogeneity among studies (I2= 72%). The response rates for metronidazole, tinidazole and secnidazole were similar (RR 1.05, 95%CI 1.01–1.09, p = 0.01; RR 1.32 95%CI 1.10–1.59, p = 0.003; and RR 1.18 95%CI 0.93–1.449, p = 0.18, respectively). On subgroup analyses, the response rates did not vary substantially and high heterogeneity persisted (I2= 57%–80%). Harmful outcomes were uncommon, and 5-NIs were associated with lower risk of abdominal pain, and higher risk of both bitter or metallic taste and headache. Conclusions: Studies investigating the efficacy of 5-NI in giardiasis treatment are highly heterogeneous. 5-NIs have a slightly better efficacy and worse profile for mild harmful outcomes in the treatment of giardiasis in comparison to controls. Larger high quality RCTs are needed to further assess efficacy and safety profiles of 5-NI.eng
dc.formatapplication/pdfspa
dc.language.isoengeng
dc.publisherPublic Library of Science (PLoS)spa
dc.relation.urlhttp://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002733spa
dc.rightsinfo:eu-repo/semantics/openAccessspa
dc.titleEfficacy of 5-Nitroimidazoles for the Treatment of Giardiasis: A Systematic Review of Randomized Controlled Trialsspa
dc.typeinfo:eu-repo/semantics/articlespa
dc.identifier.eissn1932-6203-
dc.identifier.journalPLOS Neglected Tropical Diseasesspa
dc.description.peer-reviewRevisión por paresspa
All Items in UPC are protected by copyright, with all rights reserved, unless otherwise indicated.