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
ABSTRACT
Background

Primary herpetic
 evaluate the
gingivostomatitis is
effectiveness of
a highly contagious
systemic acyclovir
infection of the oral
for primary herpetic
cavity which
gingivostomatitis
typically
P：
in childrenaffects
and young adults < 25 years of age； with a diagnosis
of primary herpetic gingivostomatitis with or without herpes labialis
children
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
Selection criteria
(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)

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
three
patients from the
placebo group were
treatment,
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,
decreasing the number of primary herpetic gingivostomatitis.


Characteristics of included studies
Characteristics of included
studies
Characteristics of excluded
studies
DATA AND ANALYSIS
checklist
author
Sequence
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
Ducoulombier
(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.