A meta-analysis of the efficacy of albendazole compared with tinidazole as treatments for Giardia infections in children

•Treatment failure is a common feature in giardiasis.•Albendazole has been suggested as an alternative to metronidazole in giardiasis.•Tinidazole is superior to albendazole against Giardia infections in children.

Metronidazole is frequently used against Giardia infection; however, it has been associated with significant failure rates in clearing parasites from the gut; additionally, as it should be taken for 5 to 10 days, it is associated with poor compliance, probably due to side effects. Other drugs, including tinidazole (TNZ) and albendazole (ABZ) have been included in the antigiardial armamentarium. Our aim was to assess the efficacy of ABZ compared with TNZ in Giardia infections in children. A systematic review and a meta-analysis were carried out. PubMed, Medline, EMBASE, CENTRAL, and LILACS were searched electronically until February 2015. Also relevant journals and references of studies included therein were hand-searched for randomised controlled trials (RCTs). The meta-analysis was limited to RCTs evaluating the use of ABZ compared with TNZ in children with Giardia infection. The assessed outcome was parasitological efficacy. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Five RCTs including 403 children were included. Overall, TNZ significantly outperformed ABZ without differences between subgroups defined by ABZ dosages [relative risk, (RR) 1.61 (95% CI): (1.40–1.85); P < 0.0001]. The 95% prediction interval range is 1.28–2.02. There was no significant heterogeneity (I2 = 0%; Q-test of heterogeneity P = 0.4507. The number-needed-to-treat, the average number of patients who need to be treated with TNZ to gain one additional good outcome as compared with ABZ was 4, 95% CI: 3–5. Our results show that TNZ outperforms ABZ in the treatment of Giardia infections in children from developing countries.