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Drugs for treating urinary schistosomiasis

  1. Anthony Danso-Appiah1,*,
  2. Jürg Utzinger2,
  3. Jianping Liu3,
  4. Piero Olliaro4

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 15 OCT 2007

DOI: 10.1002/14651858.CD000053.pub2


How to Cite

Danso-Appiah A, Utzinger J, Liu J, Olliaro P. Drugs for treating urinary schistosomiasis. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD000053. DOI: 10.1002/14651858.CD000053.pub2.

Author Information

  1. 1

    Liverpool School of Tropical Medicine, International Health Group, Liverpool, UK

  2. 2

    Swiss Tropical Institute, Department of Public Health and Epidemiology, Basel, Switzerland

  3. 3

    Beijing University of Chinese Medicine, Centre for Evidence-Based Chinese Medicine , Beijing, China

  4. 4

    World Health Organization, Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland

*Anthony Danso-Appiah, International Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. tdappiah@yahoo.co.uk.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 16 JUL 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Urinary schistosomiasis causes long-term ill-health. This review examines the various treatment options and newer drugs.

Objectives

To evaluate antischistosomal drugs, used alone or in combination, for treating urinary schistosomiasis.

Search methods

In August 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 3), MEDLINE, EMBASE, LILACS, mRCT, and reference lists of articles. We also contacted experts in schistosomiasis research.

Selection criteria

Randomized and quasi-randomized controlled trials of praziquantel, metrifonate, artemisinin derivatives, or albendazole, alone or in combination, versus placebo, different doses, or other antischistosomal drugs for treating urinary schistosomiasis.

Data collection and analysis

One author extracted data, and assessed eligibility and methodological quality, which were cross-checked by a second person. Dichotomous outcomes were combined using risk ratio (RR), and continuous data were combined using weighted mean difference (WMD); both presented with 95% confidence intervals (CI).

Main results

Twenty-four trials (6315 participants) met the inclusion criteria. Compared with placebo, participants receiving metrifonate had fewer parasitological failures at follow up at one to three months (1 trial) and three to 12 months (3 trials). Egg reduction rate was over 90%, and no adverse events were reported (1 trial). One metrifonate dose was inferior to three doses given fortnightly (both used 10 mg/kg). Praziquantel (standard single 40 mg/kg oral dose) was more effective than placebo at reducing parasitological failure at one to three months' follow up and three to 12 months. Egg reduction rates were improved with praziquantel (over 95% versus 5.3% to 64% with placebo). Mild to moderate adverse events were recorded in two trials. A comparison of metrifonate (10 mg/kg x 3, once every 4 months for one year) with praziquantel (standard dose) showed little difference in parasitological failure. For praziquantel, there was no significant difference in effect between 20 mg/kg x 2, 30 mg/kg x 1, and 20 mg/kg x 1, and the standard dose for all outcomes. One small trial of artesunate showed no obvious benefit compared with placebo, and the artesunate-praziquantel combination was similar to praziquantel alone.

Authors' conclusions

Praziquantel and metrifonate are effective treatments for urinary schistosomiasis and have few adverse events. Metrifonate requires multiple administrations and is therefore operationally less convenient in community-based control programmes. Evidence on the artemisinin derivatives is currently inconclusive, and further research is warranted on combination therapies. We suggest metrifonate be reconsidered for the WHO Model List of Essential Medicines.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Drug treatments for worms in the bladder (urinary schistosomiasis)

Worms residing in blood vessels of the bladder cause a chronic disease known as urinary schistosomiasis. The disease is commonly found in African and Eastern Mediterranean countries, especially in poor, rural areas. Humans become infected when they come into contact with contaminated water. The infection occurs when small larvae shed from snails in infected waters get into the individual through the skin and develop into adult worms that travel to the blood vessels of the bladder. There they can produce a large number of eggs, and the worm can live for three to five years. It is mainly the eggs that cause the disease. The main symptoms are blood in the urine and pain when passing urine. The eggs also cause tissue damage, and the severity of disease depends upon the intensity of the infection. Sometimes the infection can lead to bladder cancer or other kidney problems, including kidney failure. There are a number of measures that have been introduced to try to reduce the risk of infection. These include health education, improving clean water supplies and sanitation, environmental control measures to reduce numbers of intermediate host snails, and drug treatments. The review looked at the efficacy of drugs to reduce the ill-health associated with these infections. The review identified 24 trials involving 6315 people. Praziquantel and metrifonate were both found to be efficacious with few adverse events, although adverse outcomes were poorly assessed. Evidence on the artemisinins was inconclusive, and further research is warranted on combination therapies.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

治療泌尿道血吸蟲病之藥物

泌尿道血吸蟲病導致長期健康不良。這篇文獻回顧是探討各種治療方法和新藥。

目標

評估單獨或合併使用抗血吸蟲藥物治療泌尿道血吸蟲病的效果。

搜尋策略

在2007年8月,我們搜尋了Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 3), MEDLINE, EMBASE, LILACS, mRCT,以及參考文獻所列出的文章。我們還聯絡血吸蟲病專家。

選擇標準

隨機和半隨機對照試驗研究泌尿道血吸蟲病之治療以單獨或合併使用praziquantel, metrifonate, artemisinin衍生物,或albendazole,來與安慰劑、不同劑量的藥物或其他血吸蟲藥物比較。

資料收集與分析

一個作者提取數據,並評估適用性和其方法學的品質,再由第二個作者作交叉審查。使用二分類結果合併相對風險率(RR)評估,連續變數之數據則使用weighted mean difference(WMD)的方式,並且都呈現95%信賴區間(confidence intervals, CI)。

主要結論

24個試驗(6315人參加研究)符合納入標準。與安慰劑組相比,研究組接受metrifonate在1~3個月(1個臨床試驗)和3個至12個月(3個臨床試驗)追蹤時較少治療失敗。蟲卵減幅超過90%,無不良事件報告(1個臨床試驗)。一劑metrifonate的效果低於雙週給三劑(均用10毫克/公斤)。在1~3個月和3至12個月追蹤時,Praziquantel(標準單一劑量口服40毫克/公斤)的效果比安慰劑能更有效減少失敗率。使用Praziquantel蟲卵減幅也大幅改善(減幅超過95%,安慰劑減幅為5.3%到64%)。輕、中度不良事件在兩個臨床試驗中曾發生過。比較metrifonate(10 mg/kg兩週三劑,每4個月一療程為期一年)與Praziquantel(標準劑量)的效果,差別不大。使用praziquantel不同劑量,在兩劑20 mg/kg,一劑30 mg/kg,一劑20 mg/kg 以及標準劑量的所有結果並無顯著差異。一個小型試驗顯示artesunate與安慰劑相比沒有明顯的好處,artesunate和praziquantel合併使用與單用praziquantel效果相同。

作者結論

用於泌尿道血吸蟲病Praziquantel和metrifonate是有效的治療方法,幾乎沒有什麼不良反應。metrifonate需要多次投藥,因此不太方便於以社區為基礎的控制方案。關於artemisinin衍生物的治療效果,目前的醫學證據仍無結論,並值得進一步研究合併療法。我們建議重新考慮將metrifonate列入世界衛生組織標準目錄的基本藥物。

翻譯人

本摘要由三軍總醫院林斈府翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

血吸蟲居住在膀胱血管造成慢性疾病稱為泌尿道血吸蟲病。這種疾病常見於非洲和東地中海國家,特別是在貧困的農村地區。當人們接觸到受污染的水後便會受到感染。這種感染發生在蝸牛身上生長的小幼蟲感染水域後,通過皮膚進入個人體內並發展成成蟲,旅行至膀胱血管。在這裡,他們可以生產大量的蟲卵,而且血吸蟲能於此存活3到5年。蟲卵是導致疾病的主因。主要症狀是血尿和小便時疼痛。蟲卵還造成組織損傷,疾病的嚴重程度取決於感染的程度。有時感染會導致膀胱癌或其他腎臟疾病,包括腎衰竭。已經有一些措施嘗試減少感染的風險。這些措施包括衛生教育、改善清潔用水和衛生設備、減少中間宿主如:螺類的環境控制措施,以及使用藥物治療。這項文獻回顧研究了藥物的療效,用以減少不良健康環境有關的感染。研究確定了24項試驗,涵蓋了6315受試者。Praziquantel和metrifonate均有效且少有不良反應,雖然不良反應的評估作得不好。Artemisinins的效果目前證據不足,進一步研究其合併療法是必要的。