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Antibiotics for preventing pneumonia in children with measles
F Shann1, R M D'Souza, R D'Souza
1Intensive Care Unit, Royal Children's Hospital, Flemington Road, Parkville, Australia, VIC 3052. shannf@cryptic.rch.unimelb.edu.au
Background:
Measles causes more than a million deaths a year, of which most are children under five years of age who die from pneumonia.
Objectives:
The objective of this review was to assess the effects of antibiotics given to children with measles on reducing pneumonia or mortality, and to assess whether antibiotics should be given to all children with measles in communities with a high fatality rate.
Search Strategy:
We searched MEDLINE (1966 - 1999), EMBASE (1980-1999) and the specialized trials register of the Acute Respiratory Infections Group in August 1999, and all relevant journals in the University of Melbourne medical library for the years 1935-46.
Selection Criteria:
Randomised or controlled trials of antibiotics for children with measles.
Data Collection And Analysis:
Two reviewers independently extracted data and assessed trial quality.
Main Results:
Six trials with 1304 children were included. All but one of the trials were unblinded, and randomisation was either not described or was by alternate allocation. In four studies, the incidence of pneumonia in the control group was similar to that in the antibiotic prophylaxis group; in the other two studies, the incidence of pneumonia was unusually high in the control group so these children had a higher complication rate than the antibiotic group. Four of the 764 children given antibiotics died compared with one of the 637 controls.
Reviewer'S Conclusions:
The quality of the trials reviewed was poor, and they provide very weak evidence for giving antibiotics to all children with measles. Available evidence suggests that antibiotics should be given only if a child has clinical signs of pneumonia or other evidence of sepsis.
Insights
Antibiotics do not significantly reduce pneumonia or mortality in children with measles. Evidence suggests antibiotics should only be administered if pneumonia or sepsis is clinically evident.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Measles is a significant cause of mortality in children under five, primarily due to pneumonia.
- Pneumonia complicating measles contributes to over a million deaths annually worldwide.
Purpose of the Study:
- To evaluate the efficacy of antibiotic administration in reducing pneumonia and mortality in children with measles.
- To determine if routine antibiotic use in measles-affected communities with high fatality rates is warranted.
Main Methods:
- Systematic review of randomized or controlled trials of antibiotic use in children with measles.
- Searched MEDLINE, EMBASE, and specialized trial registers up to August 1999.
- Data extraction and quality assessment performed independently by two reviewers.
Main Results:
- Six trials involving 1304 children were included; most trials had poor methodology (unblinded, unclear randomization).
- Four trials showed similar pneumonia incidence between antibiotic prophylaxis and control groups.
- Four deaths occurred in the antibiotic group (764 children) versus one death in the control group (637 children).
Conclusions:
- The reviewed trials exhibit poor quality, offering weak evidence for routine antibiotic use in all children with measles.
- Current evidence supports antibiotic administration only when clinical signs of pneumonia or sepsis are present.
- Further high-quality research is needed to clarify the role of antibiotics in managing measles complications.