Antibiotics for preventing pneumonia in children with measles.
BACKGROUND
Measles causes more than a million deaths a year, of which most are children under five years of age who die from pneumonia.


OBJECTIVE
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.


METHODS
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.


METHODS
Randomised or controlled trials of antibiotics for children with measles.


METHODS
Two reviewers independently extracted data and assessed trial quality.


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.


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.
Shann
F
F
Intensive Care Unit, Royal Children's Hospital, Flemington Road, Parkville, AUSTRALIA, VIC 3052. shannf@cryptic.rch.unimelb.edu.au
D'Souza
R M
RM
D'Souza
R
R
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D008457:Measles / Q000150:complications* / Q000188:drug therapy*; D011014:Pneumonia / Q000188:drug therapy / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
D000900:Anti-Bacterial Agents