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PFAPA syndrome in children: A meta-analysis on surgical versus medical treatment
Stamatios Peridis1, Gemma Pilgrim, Emmanouel Koudoumnakis
1Department of Otolaryngology Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. peridis@gmail.com
Insights
For children with Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) syndrome, tonsillectomy offers the most effective long-term symptom resolution. Corticosteroids provide temporary relief but do not prevent future fever cycles.
Area of Science:
- Pediatric immunology
- Otolaryngology
- Clinical effectiveness research
Background:
- Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) syndrome is a common autoinflammatory disorder in children.
- Treatment options for PFAPA syndrome are varied, necessitating a comparison of their efficacy.
Purpose of the Study:
- To compare the effectiveness of medical and surgical therapies for managing PFAPA syndrome in pediatric patients.
Main Methods:
- A comprehensive literature search was conducted across major databases (Medline, Embase, Ovid, Cochrane) for studies published between 1987 and 2010.
- Random-effect meta-analytical techniques were employed to analyze outcome measures comparing surgical versus medical treatments for PFAPA syndrome.
Main Results:
- Antibiotics and cimetidine were found to be ineffective for PFAPA syndrome.
- Corticosteroids demonstrated effectiveness in symptom resolution, while tonsillectomy (+/- adenoidectomy) showed significant efficacy (P<0.00001).
- Meta-analysis confirmed surgery as significantly more effective than antibiotics or cimetidine; no significant difference was found between steroids and surgery (P=0.83).
Conclusions:
- Corticosteroids are the most effective non-surgical treatment for PFAPA syndrome, but do not prevent recurrence.
- Tonsillectomy (+/- adenoidectomy) is identified as the most effective intervention for achieving long-term resolution of PFAPA syndrome symptoms.
Objective:
To compare the range of medical and surgical therapies for children with PFAPA syndrome.
Methods:
A literature search was performed using Medline, Embase, Ovid and Cochrane databases for studies between 1987 and 2010 that compared PFAPA treatment in children (surgical versus medical). Random-effect meta-analytical techniques were conducted for the outcome measures.
Results:
The use of antibiotics and cimetidine in PFAPA syndrome are ineffective. However, there is evidence that the use of steroids is effective in the resolution of symptoms. Tonsillectomy (+/- adenoidectomy) as a treatment of PFAPA was found to be an effective intervention for resolution of symptoms (P<0.00001). Meta-analysis of surgery versus cimetidine and surgery versus antibiotics demonstrated that surgery is a significantly more effective treatment for PFAPA syndrome. A comparison of treatment with steroids or surgery did not show any statistically significant difference, confirming the effectiveness of both therapies for the resolution of PFAPA syndrome (P=0.83).
Conclusions:
The most effective non-surgical therapy is corticosteroids. However, they do not prevent future fever cycles. The results of this meta-analysis showed that tonsillectomy (+/- adenoidectomy) is the most effective intervention for long-term resolution of PFAPA syndrome symptoms.
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