Unit-dose packaged drugs for treating malaria

Abstract

Background: Unit-dose packaging of antimalarial drugs may improve the success of malaria treatments by making it easier for patients to take them correctly. Objectives: To summarize the effects of unit-dose packaged treatment on treatment failure and treatment adherence in people with uncomplicated malaria. Search strategy: We searched the Cochrane Infectious Diseases Group Specialized Register (February 2009); CENTRAL (The Cochrane Library Issue 1, 2009); MEDLINE (1966 to February 2009); EMBASE (1980 to February 2009); LILACS (February 2009); 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 and quasi-RCTs of unit-dose packaged drugs for treating uncomplicated malaria. Data collection and analysis: We independently assessed trial eligibility and risk of bias, 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 trial authors for additional information. Main results: One RCT (203 participants), three quasi-RCTs (895 participants), and one cluster-RCT (six health facilities) met the inclusion criteria. Trials were generally 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 slightly higher with blister-packed tablets compared with tablets in paper envelopes (RR 1.18, 95%CI 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 (six clusters) compared it with tablets in paper envelopes, and the other trial compared it with syrup in bottles (RR 2.15, 95% CI 1.76 to 2.61; 299 participants). Authors' conclusions: There is insufficient evidence to know if the effects of unit-dose packaged antimalarial drugs reduce 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. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.