Acyclovir for treating varicella in otherwise healthy children and adolescents

 

Abstract

Background

Acyclovir has the potential to shorten the course of illness which may result in reduced costs and morbidity associated with chickenpox.

Objectives

To examine the evidence evaluating the efficacy of acyclovir in alleviating symptoms of chickenpox and shortening the duration of illness.
To examine complications of chickenpox and adverse effects associated with acyclovir as reported in the relevant trials.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, issue 3) which contains the Acute Respiratory Infections Group's Specialized Register, MEDLINE (1950 to Septemer Week 3, 2008), and EMBASE (1974 to September 2008). The reference lists of all relevant articles were reviewed.

Selection criteria

Randomized controlled trials that evaluated otherwise healthy children zero to 18 years of age, with chickenpox.

Data collection and analysis

Two review authors independently reviewed the studies for eligibility. Two review authors independently assessed methodological quality of the relevant studies using the Jadad scale and allocation concealment. Differences were resolved by consensus. Data were extracted by one review author using a structured form and checked by a second.

Continuous data were converted to the weighted mean difference (WMD). Weighted mean differences were combined into an overall estimate using random effects. There were too few studies to consider exploring statistical heterogeneity between studies (i.e., differences in reported effects), formally, or to assess for publication bias.

Main results

Three studies were included. Study quality was three (n = 2) and four (n = 1) on the Jadad scale. Acyclovir was associated with a reduction in the number of days with fever (-1.1 days, 95% CI -1.3 to -0.9) and in reducing the maximum number of lesions (-76 lesions, -145 to -8). Results were less supportive with respect to the number of days to no new lesions and the number of days to the relief of itching. There were no clinically important differences between acyclovir and placebo with respect to complications associated with chickenpox or adverse effects associated with the treatment.

Authors' conclusions

Acyclovir appears to be effective in reducing the number of days with fever and the maximum number of lesions among otherwise healthy children with chickenpox. The results were less convincing with respect to the number of days to no new lesions and relief of itchiness. The clinical importance of acyclovir treatment in otherwise healthy children remains uncertain.

 

Plain language summary

Acyclovir can reduce the number of days with fever in otherwise healthy children with chickenpox, but its effect on sores and itching is not yet certain

Chickenpox (varicella) is caused by a virus. It begins with a fever, followed by a rash of red pimples which become itchy sores that form scabs. Chickenpox usually affects children from one to 14 years. In young babies, adults or people with impaired immune system, chickenpox is more severe. Treatments include lotions to relieve itchiness, paracetamol (acetaminophen) for fever and the antiviral drug acyclovir. The review of trials found that acyclovir reduces the number of days of fever from chickenpox in otherwise healthy children, usually without adverse effects. It is not clear whether it improves sores and itching.

 

摘要

背景

以Acyclovir治療平時健康的青少年與兒童水痘患者

Acyclovir可能縮短疾病病程﹐減少水痘造成的併發症與花費。

目標

1)檢視Acyclovir緩解水痘症狀、縮短病程的證據。2) 檢視水痘造成的併發症﹐與相關臨床試驗報告提到acyclovir造成的副作用。

搜尋策略

我們搜尋Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library, Issue 2, 2005), MEDLINE (自1966年1月到2005年6月),以及 EMBASE (1988年到2005年6月)資料庫。回顧相關文獻﹐並聯繫相關研究的第一作者與acyclovir製造藥廠。

選擇標準

針對0到18歲﹐健康兒童罹患水痘者進行的隨機對照試驗。

資料收集與分析

兩位作者各自審查研究是否符合納入條件。兩位作者以Jadad scale與隱匿分組(allocation concealment)的方法，對相關研究的研究方法品質評分。如果兩人意見不一致，則進行討論以達到共識。其中一位作者根據結構性清單擷取研究資料，另一位作者則負責檢查。將連續變數資料轉換為加權平均差(weighted mean difference, WMD)，之後根據隨機效應(random effects)模型將所有的加權平均差結合成一個估計值。然而可以納入的研究為數太少，不足以正式計算各研究之間的統計異質性(statistical heterogeneity)，也就是各研究報告效應的差異或評估出版偏差(publication bias)。

主要結論

共納入三份研究。研究品質的Jadad量表分數有兩篇為3分﹐一篇為4分。Acyclovir使用者發燒天數較短(減少1.1天，95% CI值−1.3 – −0.9)並減少病灶數量(減少76個，95% CI值−145 – −8)。然而，出痘的時間沒有明顯減少，搔癢持續時間也沒有明顯減少。Acyclovir與安慰劑治療相比，對於減少水痘的併發症與治療的副作用也沒有顯著的差異。

作者結論

Acyclovir可以減少水痘兒童患者的發燒天數﹐並減少病灶的數量。但對於減少出痘日數以及搔癢的影響則沒有定論。臨床上使用acyclovir治療健康兒童罹患水痘者的價值仍不清楚。

翻譯人

本摘要由慈濟醫院程慧娟翻譯。

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

總結

Acyclovir可以減少患水痘的健康兒童的發燒天數﹐但對於搔癢、瘡(sores)的影響則沒有定論。水痘是病毒感染所致﹐一開始先是發燒﹐然後發紅色丘疹﹐出現癢瘡﹐最後結痂。1到14歲的小朋友最常發病。嬰兒或免疫力有缺陷的人病況比較嚴重。可以治療的藥物包括止癢藥水、退燒藥acetaminophen、還有acyclovir抗病毒藥物。對臨床試驗結果進行回顧﹐顯示對健康兒童使用acyclovir可以減少發燒天數﹐通常沒有副作用。但對於瘡與搔癢的療效則沒有確切的結論。