2012 實證醫學系統課程 第一組 報告 吳敏誠、鍾宜倫、凌久惠 2012/08/07

Acyclovir for treating primary herpetic gingivostomatitis(Review) Cochrane Library 2008, Issue 4

A B S T R A C T

Background Primary herpetic gingivostomatitis is a highly contagious infection of the oral cavity which typically affects children evaluate the effectiveness of systemic acyclovir for primary herpetic gingivostomatitis P ： in children and young adults < 25 years of age ； with a diagnosis of primary herpetic gingivostomatitis with or without herpes labialis I ： acyclovir VS. placebo C ： evaluate the effectiveness of systemic acyclovir for primary herpetic gingivostomatitis. O ： Acyclovir for treating primary herpetic gingivostomatitis… only one of them could provide some weak evidence

Search methods Cochrane Oral Health Group’s Trials Register (to 22 May 2008) the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2 ) MEDLINE (1950 to 22 May 2008) EMBASE (1980 to 22 May 2008) Selection criteria Randomised controlled trials comparing acyclovir to placebo in children and young adults < 25 years of age with a diagnosis of primary herpetic gingivostomatitis with or without herpes labialis

Data collection and analysis Two review authors independently and in duplicate screened and extracted information from, and assessed the risk of bias in the included clinical trials. The Cochrane Collaboration statistical guidelines were followed for data synthesis.

Main results Only two clinical trials, one with 72 participants and the other with 20 participants were included in this review. The second study failed to report several methodological items and was inconsistent in its reporting of the outcomes measurement.

Main results The first trial, with a moderate risk of bias, showed better results in the acyclovir group compared to the placebo group in children < 6 years of age in reducing the number of individuals with oral lesions (risk ratio (RR) 0.10 (95% confidence interval (CI) 0.02 to 0.38)), new extraoral lesions (RR 0.04 (95% CI 0.00 to 0.65)), difficulty in eating (RR 0.14 (95% CI 0.03 to 0.58)), and drinking difficulties (RR 0.11 (95% CI 0.01 to 0.83)) after 8 days of treatment.

Main results individuals with difficulties experienced in eating and drinking and reducing hospital admission for children under 6 years of age with Following the onset of treatment, three patients from the placebo group were admitted to hospital for rehydration (P = 0.11). Four children (two from the acyclovir, and two from the placebo group) showed mild gastrointestinal symptoms that resolved spontaneously after 24 to 48 hours without a change in the study treatment.

Authors’ conclusions We found two relevant trials in this systematic review, only one of them could provide some weak evidence that acyclovir is an effective treatment in  reducing the number of oral lesions, ‚ preventing the development of new extraoral lesions, ƒ decreasing the number of primary herpetic gingivostomatitis.

Characteristics of included studies

Characteristics of excluded studies

DATA AND ANALYSIS

checklist authorSequence generation Allocation concealme nt Blinding of participants Blinding of researcher s Blinding of outcome assessme nt Handling of withdrawal s and losses Assessme nt of risk of bias Amir (1997 b) ++++?+moderat e Ducou- lombier (1988) +?????high

Table 1. Quality of included studies

Comparison 1. Acyclovir versus placebo

Analysis 1.1. Comparison 1 Acyclovir versus placebo, Outcome 1 The number of individuals with oral lesions (8 days after the administration of the intervention).

Analysis 1.2. Comparison 1 Acyclovir versus placebo, Outcome 2 The number of individuals who developed new extraoral lesions after the administration of the intervention.

Analysis 1.3. Comparison 1 Acyclovir versus placebo, Outcome 3 The number of individuals with eating difficulties (8 days after the administration of the intervention).

Analysis 1.4. Comparison 1 Acyclovir versus placebo, Outcome 4 The number of individuals with drinking difficulties (8 days after the administration of the intervention).

Analysis 1.5. Comparison 1 Acyclovir versus placebo, Outcome 5 The number of individuals admitted to hospital after the administration of the intervention.