Measles medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Despite the efforts made in the past years to develop a treatment regimen for measles, there is still no specific antiviral therapy for uncomplicated cases of measles, however, some drugs such as ribavirin and interferon-α have been used in the more severe cases of the condition, notably for cases of infection of the CNS by the virus. Yet, there is evidence that the administration of two doses of vitamin A in children, under the age of two, was associated with a reduced risk of morbidity and mortality from the disease. For most patients with measles, the standard treatment is focused on supportive care.[1][2][3]
Medical Therapy
According to current data, there is no antiviral therapy for measles infection and standard treatment is focused on supportive care. However, additional therapies have been used successfully to achieve a reduction in morbidity and mortality by measles infection. These Include:[1]
Supportive Care
Supportive care measures aim to minimize the damage done to the body by the viral infection, thereby, aiming to reduce the incidence of complications. This should ensure:[4]
- Adequate nutrition, to avoid nutritional deficits.
- Abundant fluid intake, to avoid dehydration caused by the loss of water through eventual vomiting or diarrhea.
- Oral rehydration solution, to replenish essential elements such as ions lost through vomiting and diarrhea.
Vitamin A
According to the WHO, children, regardless of the country of residence, who are diagnosed with measles, should receive two doses of vitamin A supplements, given 24 hours apart. During measles infection there is a natural decrease of vitamin A levels, even in the presence of adequate nutrition. Therefore, there is evidence that the administration of 2 doses of vitamin A, in consecutive days, helps restoring the vitamin A levels in the body and contributes to the decrease in morbidity, such as eye damage and blindness, and mortality from this disease. With adequate supplementation, there has been shown a reduction by 50% in the number of deaths.[2][4] For the administration of vitamin A, the WHO recommends administration once a day, in two consecutive days, of the following:
- Children <6 months of age - 50.000 IU
- Children >6 months <12 months - 100.000 IU
- Children ≥12 months - 200.000 IU
- For children who show evidence of vitamin A deficiency, a third dose, according to the above guideline, should be administered, 2-4 weeks later.
Antiviral Therapies
Although there is no specific antiviral therapy for measles infection, case reports have noted the in vitro susceptibility of measles virus to ribavirin. Also, ribavirin in parallel with other drugs, such as interferon-α, has been used in more severe cases of measles, specially when in the presence of CNS infection.[1][3]
Antibiotics
Concomitant bacterial infections constitute an important cause of morbidity and mortality in measles patients. In order to provide the best management to these patients, it is mandatory to provide prompt antibiotic treatment, whenever indicated.[1][5]
Common bacterial infections in measles patients, requiring antibiotic therapy include:[1][5][4]
Common agents of these infections include:[1][5][4]
Contraindicated Medications
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Moss, William J; Griffin, Diane E (2012). "Measles". The Lancet. 379 (9811): 153–164. doi:10.1016/S0140-6736(10)62352-5. ISSN 0140-6736.
- ↑ 2.0 2.1 Huiming Y, Chaomin W, Meng M (2005). "Vitamin A for treating measles in children". Cochrane Database Syst Rev (4): CD001479. doi:10.1002/14651858.CD001479.pub3. PMID 16235283.
- ↑ 3.0 3.1 Reuter D, Schneider-Schaulies J (2010). "Measles virus infection of the CNS: human disease, animal models, and approaches to therapy". Med Microbiol Immunol. 199 (3): 261–71. doi:10.1007/s00430-010-0153-2. PMID 20390298.
- ↑ 4.0 4.1 4.2 4.3 "Measles".
- ↑ 5.0 5.1 5.2 Kabra, Sushil K; Lodha, Rakesh; Kabra, Sushil K (2008). "Antibiotics for preventing complications in children with measles". doi:10.1002/14651858.CD001477.pub3.