Prophylactic antibiotics to prevent pneumonia and other complications after measles: community based randomised double blind placebo controlled trial in Guinea-Bissau

Abstract

Objective: To investigate whether prophylactic antibiotics can prevent complications of measles.

Design: Community based, randomised, double blind, placebo controlled trial.

Setting: Bandim Health Project study area in Bissau, Guinea-Bissau, west Africa.

Participants: 84 patients with measles during a measles epidemic in Bissau in 1998 (fewer than originally planned owing to interruption by war).

Interventions: Sulfamethoxazole-trimethoprim (co-trimoxazole) or placebo for seven days.

Main outcome measures: Pneumonia and admission to hospital. Also weight change during the first month of infection, diarrhoea, severe fever, oral thrush, stomatitis, conjunctivitis, and otitis media.

Results: The median age of the patients with measles was 5.4 (range 0.49-24.8) years. One of 46 participants who received co-trimoxazole developed pneumonia, in contrast to six of 38 participants who received placebo (odds ratio 0.08 (95% confidence interval 0 to 0.56), adjusted for age group). The number needed to treat was 7 (4 to 48). All three participants admitted to hospital had received placebo (P=0.09). The weight gain during the first month after inclusion was 15 (2-29) g/day in the placebo group and 32 (23-42) g/day in the co-trimoxazole group (P=0.04, adjusted for age group, weight for age at inclusion, measles vaccination status, and duration of disease). Significantly less conjunctivitis occurred among recipients of co-trimoxazole than placebo, as well as a non-significant tendency to less diarrhoea, severe fever, oral thrush, and stomatitis. Complications of otitis media were the same in the two groups.

Conclusions: The group that received prophylactic antibiotics had less pneumonia and conjunctivitis and had significantly higher weight gains in the month after inclusion. The results indicate that prophylactic antibiotics may have an important role in the management of measles infection in low income countries.

Trial registration: Clinical trials NCT00168532.

Conflict of interest statement

Competing interests: None declared.

Figures

Fig 1 Flowchart of decision algorithm on inclusion or exclusion of patients with measles

Fig 2 Flowchart of decision on case management and treatment failure

Fig 3 Consort flowchart