Kabra Sushil K, Lodha Rakesh
Pediatric Pulmonology Division, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029.
Cochrane Database Syst Rev. 2013 Aug 14;2013(8):CD001477. doi: 10.1002/14651858.CD001477.pub4.
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.
We searched CENTRAL 2013, Issue 4, MEDLINE (1966 to May week 4, 2013) and EMBASE (1980 to May 2013).
Randomised controlled trials (RCTs) and quasi-RCTs comparing antibiotics with placebo or no treatment, to prevent complications in children with measles.
Two review authors independently extracted data and assessed trial quality.
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.
麻疹是疫苗可预防疾病中的主要杀手；在每年170万例儿童疫苗可预防死亡病例中，约44%由麻疹导致。
评估给患麻疹儿童使用抗生素预防并发症及降低肺炎、其他疾病发病率和死亡率的效果。
我们检索了Cochrane系统评价数据库2013年第4期、MEDLINE（1966年至2013年5月第4周）和EMBASE（1980年至2013年5月）。
比较抗生素与安慰剂或不治疗以预防患麻疹儿童并发症的随机对照试验（RCT）和半随机对照试验。
两名综述作者独立提取数据并评估试验质量。
纳入了7项涉及1263名儿童的试验。大多数研究的方法学质量较差。仅有两项研究为随机双盲试验。所使用的抗生素、剂量、给药方案及结局评估存在差异。汇总研究数据显示，治疗组肺炎发病率低于对照组。然而，差异无统计学意义。在654名接受抗生素治疗的儿童中，27名（4.1%）患肺炎；而对照组609名儿童中，59名（9.6%）患肺炎（比值比（OR）0.35；95%置信区间（0.12至1.01））。1942年进行的一项试验显示使用抗生素会使肺炎发生率升高，该试验比较了口服磺胺噻唑与对症治疗。若将此试验结果从荟萃分析中剔除，则接受抗生素治疗儿童的肺炎发病率有统计学意义的降低（OR 0.26；95%CI 0.12至0.60）。接受抗生素治疗儿童的其他并发症发生率显著较低：化脓性中耳炎（OR 0.34；95%CI 0.16至0.73）和扁桃体炎（OR 0.08；95%CI 0.01至0.72）。结膜炎（OR 0.39；95%CI 0.15至1.0）、腹泻（OR 0.53；95%CI 0.23至1.22）或哮吼（OR 0.16；95%CI 0.01至4.06）的发生率无差异。未报告归因于抗生素的重大不良反应。
所综述的研究质量较差且使用的是较老的抗生素。本综述表明抗生素对预防患麻疹儿童的肺炎、化脓性中耳炎和扁桃体炎等并发症有有益作用。基于本综述，无法就抗生素类型、疗程或开始用药时间推荐明确的指南。需要更多来自高质量RCT的证据来回答这些问题。
