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Steroids for treating cerebral malaria

  • Review
  • Intervention

Authors


Abstract

Background

Cerebral malaria is associated with swelling of the brain. Corticosteroid drugs could reduce the harmful effects of this swelling, but they could also suppress host immunity to infection.

Objectives

To assess the effects of corticosteroid drugs in patients with cerebral malaria on death, life-threatening complications, and residual disability in survivors.

Search methods

In March 2008, we searched the Cochrane Infectious Disease Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 1), MEDLINE, EMBASE, LILACS, and mRCT. We also checked reference lists.

Selection criteria

Randomized controlled trials comparing corticosteroids with no corticosteroids in addition to otherwise identical treatments for patients with cerebral malaria.

Data collection and analysis

Both authors independently assessed trial eligibility and risk of bias (methodological quality), and extracted data. Outcomes sought included death, death with life-threatening complications, other complications, and disability.

Main results

Two trials with 143 participants met the inclusion criteria. There were 30 deaths in the two trials, distributed evenly between the corticosteroid and control groups (risk ratio 0.89; 95% confidence interval 0.48 to 1.68; 143 participants). Clinical complications were reported as the number of events in each trial arm and did not exclude complications occurring in fatalities. This made it difficult to interpret the reports of significantly more episodes of gastrointestinal bleeding and seizures in the corticosteroid group. Neither trial examined disability.

Authors' conclusions

There is currently no evidence of benefit from corticosteroids, but the small number of participants means it is difficult to exclude an effect on death in either direction. Data on clinical complications are difficult to assess.

摘要

背景

類固醇用於治療腦型瘧疾

腦型瘧疾會造成腦部之腫脹。皮質類固醇可降低此種腫脹情形之有害效應,但亦可能會抑制宿主對抗感染之免疫力。

目標

本回顧之目標係針對存活以及長期失能,評估類固醇對於腦型瘧疾病患之效應。

搜尋策略

我們搜尋Cochrane Infectious Diseases Group Specialized Register (2004年5月)、 CENTRAL (Cochrane Library Issue 2, 2004)、MEDLINE (1966年−2004年5月)、 EMBASE (1980年 – 2004年5月)、 LILACS (2004年5月)、現有的文獻回顧,並且聯絡本領域的專家。

選擇標準

針對腦型瘧疾之病患,在其他方面皆為相同之治療中,比較類固醇與無類固醇的隨機對照試驗。

資料收集與分析

由各個作者獨立評估收錄標準、試驗品質並摘錄數據。所欲探究之結果為死亡、因為致命性併發症而造成之死亡、其他併發症、以及失能。

主要結論

共有2項試驗符合收錄標準。在143名病患中,共有30名死亡,平均分布在類固醇及比較組中。研究者係以各試驗組中之事件數目報告臨床併發症,且其並未排除死亡者之併發症。這使得我們難以解釋類固醇組中顯著較多之胃腸出血及痙攣事件。並無任何研究針對失能障礙進行檢驗。

作者結論

目前並無證據得以顯示類固醇在此病症中之效益,但是少量之參與者數目亦意謂我們難以排除其對於死亡率之任何影響。有關臨床併發症之數據則難以進行評估。

翻譯人

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

總結

尚待概要

Plain language summary

Corticosteroids for treating cerebral malaria

Cerebral malaria is a severe form of the disease that can induce convulsions and coma; about 15% to 50% of patients with cerebral malaria will die, and 5% to 10% of survivors are left disabled as a result of brain damage.

In the past decades, health professionals often gave corticosteroids such as dexamethasone and hydrocortisone, as well as antimalarial drugs, to patients with cerebral malaria, with the aim of reducing the effects of swelling and inflammation in the brain.

This review assesses the effects of corticosteroid drugs given for cerebral malaria, on death, life-threatening complications, and residual disability in survivors.

The authors included two trials with a total of 143 patients (both adults and children). There were no significant differences in the number of deaths between the corticosteroid and control groups, and data on clinical complications were difficult to assess. Neither trial examined disability.

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