Chinese herbal medicine for hand-foot-and-mouth disease in children: An overview of systematic reviews

Objective: To summarize the use of Chinese herbal medicines (CHM) for the treatment of hand-foot-and-mouth disease (HFMD) in children and to provide high-level evidence for clinical decision-making. Methods: We conducted an overview of systematic reviews (SRs). Two English-language and four Chinese-language electronic databases were searched from inception to March 31, 2018. Published SRs and meta-analyses evaluating CHM use in children with HFMD and reporting clinically-relevant outcomes such as time to fever resolution were eligible for inclusion in this overview. Reviews were accepted if the intervention featured CHM with or without other treatment. Two authors evaluated the methodological quality of the included SRs by using ASMTAR and ROBIS. Results: Thirty SRs comprising 90 244 children with HFMD were included in this overview of SRs. All SRs were published in Chinese between 2011 and 2017. All intervention arms received CHM with or without conventional treatment and were compared against control arms receiving no treatment, conventional treatment alone, or placebo. All 30 reviews reported the time to fever resolution and results demonstrated that CHM had a greater benefit in reducing fever compared with controls. Twenty-three reviews reported the time to rash resolution which presented similar results. Fourteen SRs reported the time to oral ulcer healing and CHM demonstrated a significantly reduced time to resolution compared to controls. The quality of the included SRs was low to moderate as assessed by the AMSTAR tool. Conclusion: Published reviews demonstrated potential benefits of CHM in children with HFMD. Overall, the methodological quality of reviews included in this overview of SRs was low and our findings should be interpreted with caution. We would strongly recommend that future SRs be designed and reported rigorously following PRISMA in order to provide more robust evidence on which to base clinical guidance. Keywords: Chinese herbal medicine, Hand-foot-mouth disease, Overview, AMSTAR, ROBIS