Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America.
Hospital Pediátrico Pedro Borrás Astorga, La Habana, Cuba.
PLoS Negl Trop Dis. 2014 Mar 13;8(3):e2733. doi: 10.1371/journal.pntd.0002733. eCollection 2014 Mar.
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.
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.
贾第虫病是全世界最常见的腹泻病病因之一，5-硝基咪唑类（5-NI）是治疗贾第虫病最常开的药物。我们通过对随机对照试验（RCT）的系统评价来评估 5-NI 治疗贾第虫病的疗效。
方法/主要发现：我们在 PubMed-Medline、Scopus、Web of Science 和 Cochrane Library 中进行了全面的文献检索，以评估在寄生虫学上证实的贾第虫病患者中，5-NI 与对照（安慰剂或活性治疗）相比在寄生虫学治愈率方面的疗效。这项搜索于 2013 年 5 月进行，没有语言限制，由两位作者独立进行。疗效结果为寄生虫学治愈率，有害结果为腹痛、口苦或金属味和头痛。我们纳入了 30 项 RCT（n = 3930）。5-NI 治疗贾第虫病的应答率显著较高（RR 1.06，95%CI 1.02-1.11，p = 0.005）。研究之间存在高度异质性（I2 = 72%）。甲硝唑、替硝唑和塞克硝唑的应答率相似（RR 1.05，95%CI 1.01-1.09，p = 0.01；RR 1.32 95%CI 1.10-1.59，p = 0.003；RR 1.18 95%CI 0.93-1.449，p = 0.18）。在亚组分析中，应答率没有明显差异，且高度异质性仍然存在（I2 = 57%-80%）。有害结果并不常见，5-NI 与腹痛风险较低以及口苦或金属味和头痛风险较高相关。
研究 5-NI 治疗贾第虫病疗效的研究高度异质。与对照相比，5-NI 在治疗贾第虫病时疗效略好，但轻度不良事件的发生风险更高。需要更大规模的高质量 RCT 来进一步评估 5-NI 的疗效和安全性。
