Oral Chinese patent medicines for herpangina in children: A network meta-analysis

Herpangina, primarily caused by Enterovirus A71 and Coxsackievirus A, is characterized by fever, oropharyngeal pain, and ulcers. The prognosis is generally favorable. However, some severe cases may lead to complications such as febrile seizures and myocarditis. In recent years, clinical studies have demonstrated that combining oral Chinese patent medicines with conventional Western medicine can improve treatment efficacy.

To compare the efficacy and safety of oral Chinese patent medicines combined with conventional treatment for pediatric herpangina using network meta-analysis.

We systematically searched major Chinese and international databases from inception to January 1, 2024. Two researchers independently screened studies, extracted data, and assessed risk of bias (Cochrane tool). Statistical analysis was performed using Stata 16.0 and Review Manager 5.3 software. A network meta-analysis was conducted using a random-effects model. The odds ratio, and its 95% confidence interval (CI), were used as the effect measure for binary outcomes. The mean difference (MD), and its 95% CI, were used as the effect measure for continuous variables. Differences in efficacy and safety among interventions were compared and ranked independently.

11 oral Chinese patent medicines, 61 studies, and 6805 patients were included. The antipyretic time was ranked from best to worst as XiaoerShuangjinqingre Oral Liquid (SJQR), Lianhuaqingwen Granules (LHQW), Pudilan Anti-inflammatory Oral Liquid (PDL), XiaoerNiuhuangqingxin Powder (NHQX), Lanqin Oral Liquid (LQ), XiaoerQingyan Granules (QY), Shuanghuanglian Oral Liquid (SHL), XiaoerChaiguituire Granule (CGTR), XiaoerChiqiaoqingre Granules (CQQR), Kouyanqing Granules (KYQ), and Shufengjiedu Capsules (SFJD). The herpes regression time was ranked from best to worst as SJQR, KYQ, PDL, CQQR, SHL, NHQX, LHQW, LQ, QY, SFJD, and CGTR. The incidence of adverse reactions was ranked from lowest to highest as CQQR, PDL, LQ, CGTR, LHQW, NHQX, SJQR.

Combining oral Chinese patent medicines with conventional treatment effectively shortens the time of fever and herpes in children. Additionally, no increase in adverse events was observed in terms of safety when oral Chinese patent medicines were combined with conventional treatment. This study has been registered in the International Prospective Register of Systematic Reviews (PROSPERO), with a registration number CRD42024503831.