Antibiotics for preventing complications in children with measles: Cochrane systematic review


Assessed as up to date: 2013/05/24


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.


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.


Kabra Sushil K, Lodha Rakesh


Antibiotics for preventing complications in children with measles 

Measles is an infectious disease caused by a virus. There is an effective vaccine which can prevent measles, nevertheless 30 to 40 million people worldwide still develop measles annually. Each year measles causes more than half a million deaths and is responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children. Measles is associated with complications such as pneumonia, ear infections, throat infections, diarrhea and conjunctivitis.

Currently, the administration of two doses of vitamin A is recommended for the prevention of these complications in children below two years of age. Another method to prevent post-measles complications is to give antibiotics to children. The objective of this review was to assess the effects of antibiotics given to children with measles to reduce pneumonia, other morbidities and mortality. This review contains search results from May 2013 and included seven controlled clinical trials (1263 children), showed that children with measles who were given antibiotics had a lower incidence of pneumonia, ear infections and tonsillitis. However, there were no benefits for conjunctivitis or gastroenteritis. No major side effects attributable to administration of the study drugs were observed. As many of the studies were performed five decades ago with weak methodology using old antibiotics, there is a need for randomized controlled trials using newer antibiotics.

Reviewer's Conclusions

Implications for practice 

Measles is a public health problem in some parts of the world. This review suggests that there is a beneficial effect of antibiotic administration for children with measles in reducing the incidence of complications such as pneumonia, otitis media and tonsillitis. There is no consensus as to the type of antibiotics, duration, time of antibiotic initiation or dosage in this review, although penicillin and co-trimoxazole were found to be effective. There is a need to generate more data from well-planned randomized controlled trials (RCTs) to answer these questions.

Implications for research 

This review suggests a benefit in giving antibiotics to children with measles to reduce complications. In view of the heterogeneity of the interventions and the poor methodological quality of most of the included studies (conducted more than five decades ago), there is a need for well-designed RCTs to evaluate the effect of antibiotics in reducing pneumonia and other morbidities. Further trials are needed to evaluate the type and duration of antibiotics which are known to be effective. Available evidence suggests that two doses of vitamin A given to children below two years of age with measles may reduce mortality. However, none of the studies in this review gave vitamin A to children with measles. Vitamin A may modify the course of the illness and therefore there is a need to include vitamin A administration while conducting clinical trials for post-measles complications.

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