José M Ordóñez-Mena1, Noel D McCarthy2,3, Thomas R Fanshawe1,2. 1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK. 2. NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Oxford, Oxford, UK. 3. Warwick Medical School, University of Warwick, Coventry, UK.
Abstract
Background: Giardiasis is the commonest intestinal protozoal infection worldwide. The current first-choice therapy is metronidazole. Recently, other drugs with potentially higher efficacy or with fewer and milder side effects have increased in popularity, but evidence is limited by a scarcity of randomized controlled trials (RCTs) comparing the many treatment options available. Network meta-analysis (NMA) is a useful tool to compare multiple treatments when there is limited or no direct evidence available. Objectives: To compare the efficacy and side effects of all available drugs for the treatment of giardiasis. Methods: We selected all RCTs included in systematic reviews and expert reviews of all treatments for giardiasis published until 2014, extended the systematic literature search until 2016, and identified new studies by scanning reference lists for relevant studies. We then conducted an NMA of all available treatments for giardiasis by comparing parasitological cure (efficacy) and side effects. Results: We identified 60 RCTs from 58 reports (46 from published systematic reviews, 8 from reference lists and 4 from the updated systematic search). Data from 6714 patients, 18 treatments and 42 treatment comparisons were available. Tinidazole was associated with higher parasitological cure than metronidazole [relative risk (RR) 1.23, 95% CI 1.12-1.35] and albendazole (RR 1.35, 95% CI 1.21-1.50). Taking into consideration clinical efficacy, side effects and amount of the evidence, tinidazole was found to be the most effective drug. Conclusions: We provide additional evidence that single-dose tinidazole is the best available treatment for giardiasis in symptomatic and asymptomatic children and adults.
Background: Giardiasis is the commonest intestinal protozoal infection worldwide. The current first-choice therapy is metronidazole. Recently, other drugs with potentially higher efficacy or with fewer and milder side effects have increased in popularity, but evidence is limited by a scarcity of randomized controlled trials (RCTs) comparing the many treatment options available. Network meta-analysis (NMA) is a useful tool to compare multiple treatments when there is limited or no direct evidence available. Objectives: To compare the efficacy and side effects of all available drugs for the treatment of giardiasis. Methods: We selected all RCTs included in systematic reviews and expert reviews of all treatments for giardiasis published until 2014, extended the systematic literature search until 2016, and identified new studies by scanning reference lists for relevant studies. We then conducted an NMA of all available treatments for giardiasis by comparing parasitological cure (efficacy) and side effects. Results: We identified 60 RCTs from 58 reports (46 from published systematic reviews, 8 from reference lists and 4 from the updated systematic search). Data from 6714 patients, 18 treatments and 42 treatment comparisons were available. Tinidazole was associated with higher parasitological cure than metronidazole [relative risk (RR) 1.23, 95% CI 1.12-1.35] and albendazole (RR 1.35, 95% CI 1.21-1.50). Taking into consideration clinical efficacy, side effects and amount of the evidence, tinidazole was found to be the most effective drug. Conclusions: We provide additional evidence that single-dose tinidazole is the best available treatment for giardiasis in symptomatic and asymptomatic children and adults.
Authors: Brian Hutton; Georgia Salanti; Deborah M Caldwell; Anna Chaimani; Christopher H Schmid; Chris Cameron; John P A Ioannidis; Sharon Straus; Kristian Thorlund; Jeroen P Jansen; Cynthia Mulrow; Ferrán Catalá-López; Peter C Gøtzsche; Kay Dickersin; Isabelle Boutron; Douglas G Altman; David Moher Journal: Ann Intern Med Date: 2015-06-02 Impact factor: 25.391
Authors: Paul R Torgerson; Brecht Devleesschauwer; Nicolas Praet; Niko Speybroeck; Arve Lee Willingham; Fumiko Kasuga; Mohammad B Rokni; Xiao-Nong Zhou; Eric M Fèvre; Banchob Sripa; Neyla Gargouri; Thomas Fürst; Christine M Budke; Hélène Carabin; Martyn D Kirk; Frederick J Angulo; Arie Havelaar; Nilanthi de Silva Journal: PLoS Med Date: 2015-12-03 Impact factor: 11.069