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Meta-Analysis
. 2005 Apr 18;2005(2):CD004614.
doi: 10.1002/14651858.CD004614.pub2.

Unit-dose packaged drugs for treating malaria

L Orton  1 , G Barnish
Affiliations
Meta-Analysis

Unit-dose packaged drugs for treating malaria

L Orton et al. Cochrane Database Syst Rev. .

Abstract

Background: Unit-dose packaging of antimalarial drugs may improve malaria cure by making it easier for patients to take their treatment correctly.

Objectives: To summarize the effects of unit-dose packaged treatment on cure and treatment adherence in people with uncomplicated malaria.

Search strategy: We 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 criteria: Randomized 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 analysis: We independently assessed study eligibility and methodological quality, and extracted data for an intention to treat analysis, where possible. We combined binary data using relative risk (RR) and the fixed-effect model, and presented them with 95% confidence intervals (CI). We attempted to contact study authors for additional information.

Main results: Three 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' conclusions: There 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.

PubMed Disclaimer

Conflict of interest statement

Guy Barnish was involved in one of the included trials, however he knows of no conflicts of interest. Lois Orton has no known conflicts of interest.

Figures

1
1
Sectioned polythene bags of chloroquine (from Ghana)
2
2
Blister‐packed sulfadoxine‐pyrimethamine and amodiaquine (from Rwanda)
3
3
Blister‐packed artesunate and mefloquine (from Cambodia)
4
4
Blister‐packed artemether‐lumefantrine (trade name Coartem, Novartis)
1.1
1.1. Analysis
Comparison 1 Blister‐packed tablets and capsules versus tablets and capsules in paper envelopes, Outcome 1 Treatment adherence (measured by interview).
2.1
2.1. Analysis
Comparison 2 Tablets in sectioned polythene bags versus bottled syrup, Outcome 1 Treatment adherence (measured by interview).
3.1
3.1. Analysis
Comparison 3 Tablets in sectioned polythene bags versus polythene bags (unsectioned), Outcome 1 Treatment adherence (measured by interview).
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD004614

References

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References to other published versions of this review

Orton 2005
    1. Orton L, Barnish G. Unit‐dose packaged drugs for treating malaria. Cochrane Database of Systematic Reviews 2005, Issue 2. [Art. No.: CD004614. DOI: 10.1002/14651858.CD004614.pub2] - PMC - PubMed

MeSH terms