PFAPA syndrome in children: A meta-analysis on surgical versus medical treatment.
OBJECTIVE
To compare the range of medical and surgical therapies for children with PFAPA syndrome.


METHODS
A literature search was performed using Medline, Embase, Ovid and Cochrane databases for studies between 1987 and 2010 that compared PFAPA treatment in children (surgical versus medical). Random-effect meta-analytical techniques were conducted for the outcome measures.


RESULTS
The use of antibiotics and cimetidine in PFAPA syndrome are ineffective. However, there is evidence that the use of steroids is effective in the resolution of symptoms. Tonsillectomy (+/- adenoidectomy) as a treatment of PFAPA was found to be an effective intervention for resolution of symptoms (P<0.00001). Meta-analysis of surgery versus cimetidine and surgery versus antibiotics demonstrated that surgery is a significantly more effective treatment for PFAPA syndrome. A comparison of treatment with steroids or surgery did not show any statistically significant difference, confirming the effectiveness of both therapies for the resolution of PFAPA syndrome (P=0.83).


CONCLUSIONS
The most effective non-surgical therapy is corticosteroids. However, they do not prevent future fever cycles. The results of this meta-analysis showed that tonsillectomy (+/- adenoidectomy) is the most effective intervention for long-term resolution of PFAPA syndrome symptoms.
Peridis
Stamatios
S
Department of Otolaryngology Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. peridis@gmail.com
Pilgrim
Gemma
G
Koudoumnakis
Emmanouel
E
Athanasopoulos
Ioannis
I
Houlakis
Michael
M
Parpounas
Konstantinos
K
D000233:Adenoidectomy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002927:Cimetidine / Q000627:therapeutic use; D005334:Fever / Q000628:therapy*; D005938:Glucocorticoids / Q000627:therapeutic use; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008199:Lymphadenitis / Q000628:therapy*; D010612:Pharyngitis / Q000628:therapy*; D013281:Stomatitis, Aphthous / Q000628:therapy*; D013577:Syndrome; D014068:Tonsillectomy
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D006635:Histamine H2 Antagonists; D002927:Cimetidine