Meta-analysis of trials of prophylactic antibiotics for children with measles: inadequate evidence

Shann, Frank

doi:10.1136/bmj.314.7077.334

Cited by 18 publications

(3 citation statements)

References 22 publications

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“…Evidence for diseases affecting patient populations in developing countries tends to be particularly scarce. For example, although about 1 million people, mostly children, die every year of pneumonia complicating measles, a meta-analysis [11] showed that there have been only 6 small trials, all performed a long time ago and with very poor design and analysis standards, to address the issue of whether antibiotics have any prophylactic role in measles.…”

Section: Quantity Of the Evidencementioning

confidence: 98%

“…Yet, still, how much can we trust evidence that was obtained from "archaeological" clinical trials performed several decades ago? What can we say of trials of antibiotic prophylaxis for measles done in the 1960s [11]? Are antibiotic trials performed in the 1970s, before the widespread acquisition of b-lactamases among common upper respiratory bacteria, relevant for the management of acute sinusitis?…”

Section: Timing and Variety Of The Evidencementioning

confidence: 99%

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State of the Evidence: Current Status and Prospects of Meta-Analysisin Infectious Diseases

Ioannidis

Lau

1999

Clinical Infectious Diseases

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Meta-analysis is increasingly applied in infectious diseases to summarize clinical data and to evaluate the strength, diversity, and deficiencies of evidence for medical questions of interest. We present an overview of the current status of meta-analysis in the area of infectious diseases and the lessons learnt from its applications. Recently published meta-analyses show that several important areas of research on infectious diseases lack sufficient randomized evidence. Often evidence is scattered across a large number of small trials, making meta-analysis a promising way to integrate diverse results. Quality of trials in the field is often poor. There are several examples where evidence was accumulated primarily for marketing rather than for scientific purposes. Finally, meta-analyses are also raising the problem of what constitutes clinically significant treatment benefits, as well as interesting issues about the reproducibility of clinical evidence and its evolving nature. The increasing applications of meta-analytic methods in the study of infectious diseases may enhance data sharing and international collaborations.

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Section: Quantity Of the Evidencementioning

confidence: 98%

Section: Timing and Variety Of The Evidencementioning

confidence: 99%

State of the Evidence: Current Status and Prospects of Meta-Analysisin Infectious Diseases

Ioannidis

Lau

1999

Clinical Infectious Diseases

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“…The evidence that pneumonia in children with measles is o en caused by bacteria suggests that in countries with high casemortality it might be appropriate to give antibiotics to all children with measles. However, a systematic review showed no evidence for such a policy (Shann 1997). A previous review found no evidence that routine prophylaxis prevents pneumonia developing in children with upper respiratory tract infections caused by other viruses (Gadomski 1993).…”

Section: How the Intervention Might Workmentioning

confidence: 99%