title: A meta-analysis of the efficacy of albendazole compared with tinidazole as treatments for Giardia infections in children.
abstract: Metronidazole is frequently used against Giardia infection; however, it has been associated with significant failure rates in clearing parasites from the gut; additionally, as it should be taken for 5 to 10 days, it is associated with poor compliance, probably due to side effects. Other drugs, including tinidazole (TNZ) and albendazole (ABZ) have been included in the antigiardial armamentarium. Our aim was to assess the efficacy of ABZ compared with TNZ in Giardia infections in children. A systematic review and a meta-analysis were carried out. PubMed, Medline, EMBASE, CENTRAL, and LILACS were searched electronically until February 2015. Also relevant journals and references of studies included therein were hand-searched for randomised controlled trials (RCTs). The meta-analysis was limited to RCTs evaluating the use of ABZ compared with TNZ in children with Giardia infection. The assessed outcome was parasitological efficacy. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Five RCTs including 403 children were included. Overall, TNZ significantly outperformed ABZ without differences between subgroups defined by ABZ dosages [relative risk, (RR) 1.61 (95% CI): (1.40-1.85); P<0.0001]. The 95% prediction interval range is 1.28-2.02. There was no significant heterogeneity (I(2)=0%; Q-test of heterogeneity P=0.4507. The number-needed-to-treat, the average number of patients who need to be treated with TNZ to gain one additional good outcome as compared with ABZ was 4, 95% CI: 3-5. Our results show that TNZ outperforms ABZ in the treatment of Giardia infections in children from developing countries.
authors.affiliation: Academic Paediatric Hospital "Pedro Borrás", Calle F No. 616 esquina 27, Plaza, La Habana CP 10400, Cuba; Working Group on Zoonoses, International Society for Chemotherapy, Aberdeen, United Kingdom; Committee on Clinical Parasitology, Panamerican Association of Infectology. Electronic address: escobedo@infomed.sld.cu.
authors.forename: Angel A
authors.initials: AA
authors.lastname: Escobedo
authors.affiliation: University of the Basque Country, UPV/EHU and CIBERSAM, Medical School-Department of Neuroscience, Barrio Sarriena S/N, Leioa, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Ballesteros
authors.affiliation: Institute of Psychiatric Research, Egaña 10, 48010 Bilbao, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: González-Fraile
authors.affiliation: Committee on Clinical Parasitology, Panamerican Association of Infectology; Municipal Centre of Hygiene, Epidemiology and Microbiology "Plaza", Calle 8 No. 406 esquina a 19, Plaza, La Habana CP 10400, Cuba.
authors.forename: Pedro
authors.initials: P
authors.lastname: Almirall
mesh_terms: D000293:Adolescent; D015766:Albendazole / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005872:Giardia / Q000187:drug effects*; D005873:Giardiasis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D014011:Tinidazole / Q000627:therapeutic use*
chemical_list: D014011:Tinidazole; D015766:Albendazole
keywords: Children; Giardia infection; Giardiasis; Meta-analysis; Systematic review