title: The role of artesunate for the treatment of urinary schistosomiasis in schoolchildren: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Efficacy of artemisinin derivatives alone or in combination compared to praziquantel alone for the treatment of urinary schistosomiasis in schoolchildren.
  
  
  METHODS
  Randomized clinical trials comparing praziquantel with artemisinin derivatives in the treatment  of urinary schistosomiasis in schoolchildren were included. Medline, EMBASE, LILACS, CENTRAL, African Index Medicus, and Scielo were searched. We also analyzed the abstracts of the main conferences on infectious diseases and tropical medicine during the years 2009-2011. Google Scholar  and OpenSIGLE were also searched. The last search was performed in July 2012. The primary endpoint was the cure rate. The main outcome data were retrieved using a standardized form; three independent researchers (WP, HC, and SS) performed the search, retrieved data, and evaluated the risk  of bias. Disagreements were resolved by discussion. Risk ratios were used and heterogeneity was evaluated. A fixed or random-effects model was used according to the results of heterogeneity testing. An intention-to-treat analysis was done. Data were analyzed using Revman 5·0·24  (Copenhagen: The Nordic Cochrane Centre).
  
  
  RESULTS
  Seven studies were selected for full text review and only five studies were finally included. The cure rate for praziquantel was superior to that of artesunate (RR: 1·66; 95% CI: 1·18-2·33). Artesunate  was not clearly superior to placebo (artesunate versus placebo, RR: 3·21; 95% CI: 0·50-20·74). Combination of artesunate with praziquantel could prove more beneficial than praziquantel alone (RR: 1·15; 95% CI: 1·01-1·31). The frequency  of adverse events was equivalent for both drugs (praziquantel versus artesunate, RR: 1·11; 95% CI: 0·80-1·55).
  
  
  CONCLUSIONS
  Our meta-analysis showed that praziquantel was significantly more effective than artesunate for the treatment of urinary schistosomiasis  in schoolchildren. Artesunate at best had a marginal role in combination therapy.
authors.affiliation: Internal Medicine Department, Hospital Universitario de San Juan de Alicante, N-332 km, 52 S/N CP, 03550 San Juan de Alicante, Spain. Wikman.philip@gmail.com
authors.forename: Philip Erik
authors.initials: PE
authors.lastname: Wikman-Jorgensen
authors.forename: César Augusto
authors.initials: CA
authors.lastname: Henríquez-Camacho
authors.forename: Sergio
authors.initials: S
authors.lastname: Serrano-Villar
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Pérez-Molina
mesh_terms: D000293:Adolescent; D000871:Anthelmintics / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D000077332:Artesunate; D002648:Child; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011223:Praziquantel / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012553:Schistosomiasis haematobia / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D037621:Artemisinins; D000077332:Artesunate; D011223:Praziquantel