Antibiotics for preventing complications in children with measles

BACKGROUND

Measles is the leading killer among vaccine-preventable diseases; it is responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children annually.

OBJECTIVES

To assess the effects of antibiotics given to children with measles to prevent complications and reduce pneumonia, other morbidities and mortality.

SEARCH METHODS

We searched CENTRAL 2013, Issue 4, MEDLINE (1966 to May week 4, 2013) and EMBASE (1980 to May 2013).

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs comparing antibiotics with placebo or no treatment, to prevent complications in children with measles.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed trial quality.

MAIN RESULTS

Seven trials with 1263 children were included. The methodological quality of most studies was poor. Only two studies were randomized, double-blind trials. There was variation in antibiotics used, their doses, schedule and evaluation of outcome. 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. Of the 654 children who received antibiotics, 27 (4.1%) developed pneumonia; while out of 609 children in the control group, 59 (9.6%) developed pneumonia (odds ratio (OR) 0.35; 95% confidence interval (0.12 to 1.01). 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, there is a statistically significant reduction in the incidence of pneumonia in children receiving antibiotics (OR 0.26; 95% CI 0.12 to 0.60). 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). No major adverse effects attributable to antibiotics were reported.

AUTHORS' CONCLUSIONS

The studies reviewed were of poor quality and used older antibiotics. This 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 recommend definitive guidelines on the type of antibiotic, duration or the day of initiation. There is a need for more evidence from high-quality RCTs to answer these questions.

Antibiotics for preventing complications in children with measles

BACKGROUND

Measles is the leading killer among vaccine-preventable diseases, responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children annually.

OBJECTIVES

To assess the effects of antibiotics given to children with measles to prevent complications and reduce pneumonia, other morbidities and mortality.

SEARCH STRATEGY

In 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 CRITERIA

Randomized controlled trials (RCTs) and quasi-RCTs comparing antibiotics with placebo or no treatment to prevent complications in children with measles.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed trial quality.

MAIN RESULTS

Seven 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' CONCLUSIONS

This 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.

Dexamethasone reduces reintubation rate due to postextubation stridor in a high-risk paediatric population

OBJECTIVE

To study the effect of dexamethasone on postextubation stridor (PS) incidence and reintubation rate due to PS in a high-risk paediatric intensive care population.

PATIENTS AND METHODS

All children aged between 4 wk and 6 y, who were intubated for at least 24 h and extubated between August 1999 and May 2002, were retrospectively included (n=60). Medical records of the included patients were studied; records of patients treated with dexamethasone prior to and following extubation (n=23) were compared with control patients who had not received prophylactic medication (n=37).

RESULTS

Nine patients in the control group developed significant postextubation stridor, necessitating nebulized epinephrine or glucocorticosteroids. In six of these children, reintubation as a result of postextubation stridor was indicated. None of the patients treated with dexamethasone developed severe postextubation stridor or required reintubation.

CONCLUSIONS

The risk of postextubation stridor is relatively high in the group of children aged between 4 wk and 6 y with intubation exceeding 24 h. We found dexamethasone to be effective in preventing reintubation due to postextubation stridor in this paediatric high-risk group.

[Croup in children--results of prospective, multicenter observation]

Croup syndrome is an urgent and frequent reason for hospitalization of children.

MATERIAL AND METHODS

632 children with croup syndrome (422 boys and 210 girls aged 2 months-17 years) admitted to 15 pediatric departments in Lower Silesia were prospectively observed for 12 months (from April 2001 to March 2002). We conducted prospective survey of clinical and laboratory data from all study centers.

RESULTS

Following diagnoses were accepted as the croup syndrome: subglottic laryngitis in 482 patients (75.4%), laryngotracheobronchitis in 75 (11.8%), laryngitis in 50 (7.8%) and epiglottitis in 20 children (3%). The most severe course was observed in children with epiglottitis. Four of them required airway intervention and had endotracheal intubation. H. influenzae b was cultured from blood of one patient. The most cases of epiglottitis occurred in the 3rd year of life (45%).

CONCLUSIONS

1. The most common reason of croup was subglottic laryngitis. 2. Epiglottitis was rare with serious course of disease; frequency was comparable with the frequency seen in European countries before the implementation of Hib vaccine. The routine use of Hib vaccine in Poland may prevent from children life threatening epiglottis cases.

Vitamin A for preventing secondary infections in children with measles--a systematic review

The objective of the present study was to determine whether vitamin A prevents pneumonia, diarrhoea and other infections in children with measles. A meta-analysis was carried out of randomized controlled trials identified through a systematic search of the medical literature for studies that used vitamin A to treat measles. A total of 492 children, aged from 6 months to 13 years, were supplemented with vitamin A, and 536 children were given placebo in six trials, five of which were conducted in hospitals and one in a community setting. The main outcome measures were: incidence of pneumonia, diarrhoea, croup, and otitis media; and duration of pneumonia, diarrhoea, fever and hospitalization. There was no significant reduction in the incidence of pneumonia or diarrhoea but there was a 47 per cent reduction in the incidence of croup (RR = 0.53; 95 per cent CI = 0.29-0.89) in children who were treated with 200 000 IU of vitamin A on 2 consecutive days. Only one study reported a 74 per cent reduction in the incidence of otitis media (RR = 0.26 95 per cent CI = 0.05-0.92). There was a statistically significant decrease in the duration of diarrhoea, pneumonia, hospital stay and fever in individual studies. It was concluded that vitamin A does have a beneficial effect on morbidity associated with measles and should be used as a treatment for hospitalized measles cases.