Comparative effectiveness and safety of xiyanping with ribavirin for rotavirus enteritis therapy in childhood: A systematic review and meta-analysis

Xin Jia,Hongying Duo,Baoping He,Jichun Wang,Dongmei Song,Hongai Liu

doi:10.4314/tjpr.v17i1.23

Abstract

Purpose : To employ meta-analysis to assess the effectiveness and adverse events of Xiyanping and ribavirin in children with rotavirus enteritis. Methods : Searches included PubMed, Embase, Medline, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine Database (CBM), China Science and Technology Journal Database (VIP database), and Wanfang database from inception to March 2017. Clinical indicators, with respect to the total effectiveness rate, fever time, duration of diarrhea, creatinine kinase MB isoenzyme (CK-MB), rotavirus (RV) negative conversion rate, and adverse reaction, were compared between Xiyanping and ribavirin groups. Results : Five-hundred and twenty-six records were obtained after searching the databases, and 18 studies (3557 participants) that met the inclusion criteria were included. All of them assessed total effectiveness rate, and two records evaluated RV negative conversion rate. There were significantly higher rates in the Xiyanping group than in the ribavirin group {OR = 3.76, 95 %CI (3.03 - 4.66), p < 0.00001; OR = 2.68, 95 %CI (1.56 - 4.60), p = 0.0004}. Compared with ribavirin group, fever time, duration of diarrhea, and creatine kinase isoenzyme MB (CK-MB) were significantly lower in xiyanping group [MD = -1.23, 95 %CI (-1.64 to -0.81), p < 0.00001; MD= -2.15, 95 %CI (-2.68 to -1.62), p < 0.00001; MD = -16.90, 95 %CI (-17.23 to -16.57), p < 0.00001}. Six studies reported adverse reactions, but there was no significant difference between xiyanping and ribavirin groups {OR = 1.44, 95 %CI (0.40 - 5.17), p = 0.58}. Conclusion : This review suggests that xiyanping is more effective than ribavirin in children suffering from rotavirus enteritis. Keywords : Ribavirin, Rotavirus enteritis, Systematic review, Virazole®, Xiyanping

Highlights

Rotavirus (RV) causes acute vomiting, diarrhea, and fever, and is a major cause of enteritis in infants and children younger than 5 years of age, with an estimated 2 million hospitalizations and 450,000 to 700,000 deaths worldwide per year [1]
The following criteria had to be met in this metaanalysis: (1) age range between 28 days and 18 y; (2) randomized controlled trials (RCTs); (3) all subjects with rotavirus enteritis should fulfill the standard accepted diagnostic criteria with RVpositive cases [7]; (4) two groups treated by Xiyanping or ribavirin (Xiyanping vs ribavirin) and the duration of medication above three days; (5)
18 studies [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26] reported the total effectiveness rate, four studies [11,14,20,25] evaluated fever time, 4 studies [10,11,14,20] related the duration of diarrhea, 3 studies [13,17,22] reported creatinine kinase MB isoenzyme (CK-MB), 2 studies were related to the RV-negative conversion rate (RSV) [17,22], and six studies

Summary

Introduction

Rotavirus (RV) causes acute vomiting, diarrhea, and fever, and is a major cause of enteritis in infants and children younger than 5 years of age, with an estimated 2 million hospitalizations and 450,000 to 700,000 deaths worldwide per year [1]. Rotavirus enteritis often occurs in autumn and winter in China [2]. There are no unique antiviral drugs for RV enteritis in China, and ribavirin and Xiyanping injections are usually used. Xiyanping has been used in China for many years, as it possesses antibacterial, anti-inflammatory, and antiviral activities [5, 6]. To derive a more precise evaluation on the effectiveness of ribavirin and Xiyanping in patients with rotavirus enteritis, a meta-analysis was performed

Methods

Results

Conclusion