Antibiotics for preventing pneumonia in children with measles
Related Experiment Videos
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 leading cause of mortality in children under five, primarily due to pneumonia.
- Pneumonia complicating measles presents a significant global health challenge, particularly in vulnerable populations.
Purpose of the Study:
- To evaluate the efficacy of antibiotic administration in reducing pneumonia and mortality among children diagnosed with measles.
- To determine the appropriateness of routine antibiotic use for all measles cases in high-fatality regions.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and controlled trials involving antibiotic use in children with measles.
- Comprehensive literature search across major databases (MEDLINE, EMBASE) and specialized registers up to August 1999.
- Independent data extraction and quality assessment by two reviewers.
Main Results:
- Six trials encompassing 1304 children were included; most trials had methodological limitations (unblinded, poor randomization).
- Four trials showed similar pneumonia incidence between antibiotic prophylaxis and control groups; two showed higher pneumonia rates in controls.
- Mortality data indicated 4 deaths among 764 children receiving antibiotics versus 1 death among 637 controls.
Conclusions:
- The available evidence from reviewed trials is of low quality, providing weak support for routine antibiotic administration in all measles cases.
- Current evidence suggests a targeted approach: antibiotics should be reserved for children exhibiting clinical signs of pneumonia or sepsis.
- Further high-quality research is needed to definitively establish the role of antibiotics in managing measles complications.
Related Concept Videos
01:29Respiratory Syncytial Virus Disease
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:25Mechanism of Antibiotic Resistance in MRSA
01:14Atypical Pneumonia
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.
01:30Pneumonia III: Complications and Assessment