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Unit-dose packaged drugs for treating malariaOrton LC, Barnish G
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SummaryUnit-dose packaging of antimalarial drugs may improve treatment adherence, but there is little good quality evidence to say if it improves the effectiveness of treatmentMalaria is a parasitic disease spread by mosquitoes in areas such as sub-Saharan Africa, South-East Asia and South America. Millions of people are infected with malaria each year. It is thought that packaging a course of treatment in units of a single dose may better ensure the correct dosage is taken, thus increasing the success of treatment. The review found insufficient good quality evidence from randomized controlled trials to determine if unit-dose packaging of drugs saves lives, but there is some indication that it might improve treatment adherence. More research is needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 20. 2005 AbstractBackgroundUnit-dose packaging of antimalarial drugs may improve malaria cure by making it easier for patients to take their treatment correctly. ObjectivesTo summarize the effects of unit-dose packaged treatment on cure and treatment adherence in people with uncomplicated malaria. Search strategyWe searched the Cochrane Infectious Diseases Group Specialized Register (November 2004); CENTRAL (The Cochrane Library Issue 4, 2004); MEDLINE (1966 to November 2004); EMBASE (1980 to November 2004); LILACS (November 2004); conference proceedings, and reference lists of articles. We also contacted pharmaceutical companies, organizations, and researchers in the field. Selection criteriaRandomized controlled trials (RCTs), cluster-RCTs, quasi-RCTs, and controlled before-and-after studies of unit-dose packaged drugs for treating uncomplicated malaria. Data collection and analysisWe independently assessed study eligibility and methodological quality, and extracted data for an intention to treat analysis, where possible. We combined binary data using risk ratio(RR) and the fixed-effect model, and presented them with 95% confidence intervals (CI). We attempted to contact study authors for additional information. Main resultsThree quasi-RCTs (895 participants) and one cluster-RCT (6 health facilities) met the inclusion criteria. Trials were of poor methodological quality, and none adequately assessed treatment failure. Unit-dose packaged drugs (in conjunction with prescriber training and patient information) appeared to be associated with higher participant-reported treatment adherence in all trials. A meta-analysis of two trials (596 participants) showed that participant-reported treatment adherence was higher with blister-packed tablets compared with tablets in paper envelopes (RR 1.18, 1.12 to 1.25). Two trials using tablets in sectioned polythene bags as the intervention also noted an increase in participant-reported treatment adherence: the cluster-RCT (6 clusters) compared it with tablets in paper envelopes, and the other trial compared it with syrup in bottles (RR 2.15, 1.76 to 2.61; 299 participants). Authors' conclusionsThere is insufficient evidence to determine the effect of unit-dose packaged antimalarial drugs on treatment failure. Unit-dose packaging supported by prescriber training and patient information appears to improve participant-reported treatment adherence, but these data come from trials with methodological limitations. |