Should we abandon quinine plus antibiotic for treating uncomplicated falciparum malaria? A systematic review and meta-analysis of randomized controlled trials

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• 作者：Tianzhang Song ; Jintao Chen ; Lilin Huang ; Wenjia Gan ; Hongling Yin…
• 关键词：Uncomplicated falciparum malaria ; Quinine ; PubMed
• 刊名：Parasitology Research
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：115
• 期：3
• 页码：903-912
• 全文大小：2,843 KB
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• 作者单位：Tianzhang Song (1) (2)
  Jintao Chen (3)
  Lilin Huang (4)
  Wenjia Gan (5)
  Hongling Yin (1) (2)
  Juan Jiang (1) (2)
  Tailong He (4)
  Huaiqiu Huang (4)
  Xuchu Hu (1) (2)
  
  1. Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
  2. Education Ministry Key Laboratory for Tropical Disease Control Research, Sun Yat-sen University, Guangzhou, Guangdong, China
  3. Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong, China
  4. Department of Dermatology and Venereology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
  5. School of Biomedical Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong
  
• 刊物类别：Biomedical and Life Sciences
• 刊物主题：Biomedicine
  Medical Microbiology
  Microbiology
  Immunology
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-1955

文摘

In this study, we compared the efficacies and adverse effects of quinine plus antibiotics and other anti-malaria drugs on treating uncomplicated falciparum malaria. By systematically searching the major databases PubMed, Embase, and the Cochrane Library, 14 randomized controlled trials (RCTs) including 1996 cases were identified. Then, we performed a systematic review and cumulative meta-analysis on these data. The primary outcome of these treatments was parasite failure at day 28. There was no significant difference between quinine plus antibiotic therapy (QACT) and artemisinin-based therapies (odds ratio (OR) 0.69, 95 % confidence interval (CI) 0.28 to 1.71) or non-artemisinin-based therapies except quinine monotherapy and chloroquine monotherapy (OR 0.56, 95 % CI 0.18 to 1.74). The secondary outcome was the adverse effects within 28 days, including nausea, dizziness, vomiting, diarrhea, abdominal pain, headache, and tinnitus. QACT significantly increased the risk of tinnitus compared with artemisinin-based therapies (OR 111.65, 95 % CI 12.63 to 986.87) and non-artemisinin-based therapies (OR 48.16, 95 % CI 16.23 to 142.92). Vomiting was more frequently reported in QACT compared with non-artemisinin-based therapies (OR 2.02, 95 % CI 1.14 to 3.56). This meta-analysis suggests that almost all regimens have equivalent treatment effect at the 28th day. However, the patients with QACT had a higher chance to suffer from vomiting and tinnitus. Therefore, QACT does not have significant advantage on treating uncomplicated falciparum malaria.