Perhaps I
have misunderstood this, but it seems that in those studies where the control
groups (those not getting antibiotics) had more pneumonia, but they also had a
considerably lower death rate (1/637 in the no antibiotics group vs 1/191 in
the antibiotics group). So the
antibiotics may have prevented pneumonia but caused deaths. Fair trade?
You decide.
From
Cochrane Review
Abstracts
Antibiotics for preventing pneumonia in children with measles
Shann
F, D'Souza RM, D'Souza R
A substantive amendment to this systematic review was last made on 10
December 1998. Cochrane reviews are regularly checked and updated if
necessary.
Data collection and analysis: Two reviewers independently extracted data
and
assessed trial quality.
Citation: Shann F, D'Souza RM, D'Souza R. Antibiotics for preventing
pneumonia in children with measles (Cochrane Review). In: The Cochrane
Library, Issue 3, 1999. Oxford: Update Software.
Background and objectives: Measles causes more than a million deaths a
year,
of which most are children under five years of age who die from pneumonia.
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.
Reviewers' conclusions: The quality of the trials reviewed was poor, and
they
provide 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.
Search strategy: We searched Medline (to 1998), and all relevant
journals in
the University of Melbourne medical library for the years 1935-46.
Selection criteria: Randomised or controlled trials of antibiotics for
children with measles.
Main 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.
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