Efficacy and safety of metronidazole versus a combination of metronidazole and diiodohydroxyquinoline for the treatment of patients with intestinal amebiasis: a primary care physician research group study

Antiamoebic drugs for treating amoebic colitis

“…Seventeen trials reported that a pharmaceutical company provided funding (Nnochiri 1967; Batra 1972; Naoemar 1973; Pudjiadi 1973; Panggabean 1980; Sitepu 1982; Tripathi 1986; Chunge 1989; Pamba 1990; Rossignol 2001; Rossignol 2007), or supplied study drugs (Kapadia 1968; Rubidge 1970; Misra 1974; Joshi 1975; Singh 1977; Davila 2002). Two trials reported that at least one trial author was connected with the pharmaceutical company manufacturing the study drug (Asrani 1995; Salles 1999), although study authors did not describe the level of involvement of the company. One trial was funded by the university at which study authors were affiliated (Siddiqui 2015).…”

“…Two trials reported the duration of time from start of treatment to disappearance of E histolytica from stools (Naoemar 1973; Pudjiadi 1973). Four trials reported on the number of stools passed at different periods: during treatment (Savas‐Erdeve 2009); after treatment (Pudjiadi 1973); and during treatment and on follow‐up after treatment (Botero 1977; Tripathi 1986), while another reported average daily frequency of stools on admission and at the end of days 5 and 10 of treatment (Asrani 1995). One trial assessed clinical and parasitological outcomes jointly as ‘cure' (Prasad 1985); only dichotomous outcomes were included in the analysis because of inconsistency in reporting continuous data (see Table 18).…”

“…One trial was reported as ‘single‐blind', but it is unclear who was blinded (Misra 1974). Four trials were open trials (Pehrson 1984; Asrani 1995; Salles 1999; Savas‐Erdeve 2009), and three were unclear regarding blinding (Kapadia 1968; Misra 1977; Misra 1978). We assessed the other 12 trials as being at high risk of performance and detection bias because researchers used different dosages and regimens of study drugs and did not mention blinding procedures.…”

“…Three trials did not report the number of participants who developed adverse events (Sitepu 1982; Chunge 1989; Karabay 1999), and five trials incompletely reported adverse events (Pehrson 1984; Pamba 1990; Mohammed 1998; Davila 2002; Shah 2016). The presence of selective reporting bias was unclear in 10 trials owing to the following: Three trials did not report results of rectosigmoidoscopy, even if this was pre‐specified as a criterion for enrolment and/or clinical cure (Joshi 1975; Mathur 1976; Misra 1977); one trial reported outcomes only as duration from start of treatment until disappearance of blood or parasites from the stools (Batra 1972); and six trials provided incomplete reporting of adverse events (Nnochiri 1967; Huggins 1982; Tripathi 1986; Chunge 1989; Asrani 1995; Mansour‐Ghanaei 2003). In addition, two trials included an analysis that was not pre‐specified: frequency of loose stools per day and rate of disappearance of parasites in stools (Tripathi 1986); and time from first dose to passage of last unformed stools shown on a survival analysis graph (Rossignol 2007).…”

“…Heterogeneity could be explained by differences in severity of illness and variable drug combinations used. c Downgraded by 1 for indirectness: trials were conducted in countries that are endemic for amoebiasis (India ‐ Asrani 1995 and Prasad 1985 ‐ and South Africa ‐ Rubidge 1970) but used various drug combinations. Studies using different combination of drugs would need to be studied.…”