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WITHDRAWN: Antibiotics for preventing pneumonia in children with measles
F Shann1, R M D'Souza, R D'Souza
1Royal Children's Hospital, Intensive Care Unit, 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.
Authors' 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 death in children under five, primarily due to pneumonia.
- Pneumonia complicating measles significantly increases mortality rates in young children.
Purpose of the Study:
- To evaluate the efficacy of antibiotics in reducing pneumonia and mortality in children with measles.
- To determine if routine antibiotic administration is warranted for measles patients in high-fatality areas.
Main Methods:
- Systematic review of randomized or controlled trials of antibiotics for children with measles.
- Searched MEDLINE, EMBASE, and other databases up to August 1999.
- Data extraction and quality assessment by two independent reviewers.
Main Results:
- Six trials involving 1304 children were included; most trials had poor methodological quality.
- Antibiotic prophylaxis did not consistently reduce pneumonia incidence across studies.
- Mortality was slightly higher in the antibiotic group (4/764) compared to the control group (1/637).
Conclusions:
- The evidence supporting routine antibiotic use in all children with measles is weak due to poor trial quality.
- Antibiotics should be reserved for children with measles who exhibit clinical signs of pneumonia or sepsis.
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