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Antibiotics for preventing complications in children with measlesKabra SK, Lodha R, Hilton DJ
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SummaryAntibiotics for preventing complications in children with measlesMeasles is an infectious disease caused by a virus. There is an effective vaccine that can prevent measles, however 30 to 40 million people annually still develop measles worldwide. Each year measles causes more than half a million deaths and is responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children. Measles is associated with complications such as pneumonia, ear infections, throat infections, diarrhea and conjunctivitis. Currently, the administration of two doses of vitamin A is recommended for the prevention of these complications in children below two years of age. Another method to prevent post-measles complications is to give antibiotics to children. The objective of this review was to assess the effects of antibiotics given to children with measles in reducing pneumonia, other morbidities and mortality. A review of seven controlled clinical trials which included 1385 children, showed that children with measles who were given antibiotics had a lower incidence of pneumonia, ear infections and tonsillitis. However, there were no benefits for conjunctivitis or gastroenteritis.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 26. 1999 AbstractBackgroundMeasles is the leading killer among vaccine-preventable diseases, responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children annually. ObjectivesTo assess the effects of antibiotics given to children with measles to prevent complications and reduce pneumonia, other morbidities and mortality. Search strategyIn this 2008 update we searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1) MEDLINE (1966 to January week 1, 2008), EMBASE (1980 to December 2007) and the National Research Register (Issue 3, 2007). Selection criteriaRandomized controlled trials (RCTs) and quasi-RCTs comparing antibiotics with placebo or no treatment to prevent complications in children with measles. Data collection and analysisTwo review authors independently extracted data and assessed trial quality. Main resultsSeven trials with 1385 children were included. Pooled study data showed that the incidence of pneumonia was lower in the treatment group compared to the control group. However, the difference was not statistically significant. In children who received antibiotics, 1.9% developed pneumonia, while in the control group 6% developed pneumonia (OR 0.28; 95% CI 0.06 to 1.25). The one trial that showed an increase in the rate of pneumonia with antibiotics was conducted in 1942 and compared oral sulfathiazole with symptomatic treatment. If the results of this trial are removed from the meta-analysis, and the remaining six studies are combined, there is a statistically significant reduction in the incidence of pneumonia in children receiving antibiotics (OR 0.17; 95% CI 0.05 to 0.65). The number needed to treat to prevent one episode of pneumonia is 24 patients. The incidence of other complications was significantly lower in children receiving antibiotics: purulent otitis media (OR 0.34; 95% CI 0.16 to 0.73) and tonsillitis (OR 0.08; 95% CI 0.01 to 0.72). There was no difference in the incidence of conjunctivitis (OR 0.39; 95% CI 0.15 to 1.0), diarrhea (OR 0.53; 95% CI 0.23 to 1.22) or croup (OR 0.16; 95% CI 0.01 to 4.06). Authors' conclusionsThis review suggests a beneficial effect of antibiotics in preventing complications such as pneumonia, purulent otitis media and tonsillitis in children with measles. On the basis of this review, it is not possible to give definitive guidelines on the type of antibiotic, duration, or the day of initiation. Use of penicillin or co-trimoxazole may be considered. There is a need to generate more evidence by well planned RCTs to answer these questions. |