5.3 Treatment of uncomplicated cases

An uncomplicated case is a case with either no complications or one or more minor complications that can be treated on an outpatient basis.

The standard treatment consists of treating the fever (if poorly tolerated) and preventing the most common complications.

The WHO does not recommend routine antibiotic prophylaxis for uncomplicated cases [1]Citation 1.World Health Organization (WHO). Measles Outbreak Guide. Geneva: WHO; 2022. 
https://www.who.int/publications/i/item/9789240052079  . However, MSF recommends antibiotic prophylaxis in most projects for all uncomplicated measles cases in children under 5 years, due to the additional risks inherent in the context: situations where identifying and/or treating secondary bacterial infections is not possible (problems with access to care and limited capacity of health services) and where there are a large number of vulnerable people.

A five-day course of antibiotics (amoxicillin PO, unless there is known resistance in the area) is given as a preventive measure to children under 5 years with measles. There is no change in the treatment if the child has non-severe pneumonia or acute otitis media, since first-line treatment for these infections is the same as the routine standard antibiotic prophylaxis. 

The treatment for uncomplicated cases includes the routine standard treatment 
AND treatment for one or more minor complications (for dosage by weight or age, see Appendix 13)

5.3.1 Standard treatment for uncomplicated cases

• Antipyretic: paracetamol PO (tablet) depending on the fever, taken 3 or 4 times every 24 hours for 2 to 3 days, if needed.
• Antibiotic treatment: amoxicillin PO
  • Children < 5 years: routine amoxicillin PO for 5 days
  • Children ≥ 5 years:   
    • For pneumonia with no severe signs: start antibiotic treatment with amoxicillin PO for 5 days.  If no improvement after 48 hours, the child should be seen again in consultation to look for complicated pneumonia.
    • For acute otitis media: if the child can return for consultation, monitor progress for 48 hours to decide whether antibiotic treatment is needed; otherwise, treat with amoxicillin PO for 5 days. 
• Vitamin A: retinol PO on D1 and D2. The D3 should be given 4-6 weeks after aCitation a.If, for practical reasons, this 4- to 6-week time frame is difficult to maintain, the third dose can be given on D8. For pregnant women (ask the patient), it is better to give a lower dose, i.e., 25,000 IU per week for 4 weeks. .
• Clean the eyes with clean water
• Clear upper airways: blow the child’s nose to prevent congestion and secondary respiratory infection and improve the child’s comfort (especially during breastfeeding) and sleep. Nasal lavage with 0.9% sodium chloride solution may be helpful in relieving significant nasal congestion (See Appendix 15).
• Hydration + caloric feeding, small frequent meals (every 2 to 3 hours) or more frequent breastfeeding.
• To prevent post-measles malnutrition: if the situation justifies it (food insecurity or activity deemed operationally pertinent), children under age 5 years should receive nutritional supplementation in the form of ready-to-use supplementary foods (RUSF) or ready-to-use therapeutic foods (RUTF), 500 kcal per day for 2 weeks.

5.3.2 Treatment for minor complications in uncomplicated cases

• Pneumonia with no severity criteria: amoxicillin PO for 5 days (give to children over 5 years who did not receive it routinely).
• Acute otitis media: treat the fever and pain and see back in 48 hours if antibiotic therapy is needed in children > 5 years, then add amoxicillin PO for 5 days (see above).
• Mild croup: dexamethasone or prednisolone PO
  • Keep the child calm and reassured, place in the parent’s arms or in a sitting position to help breathing, as agitation and crying worsen the symptoms.
  • Give standard symptomatic treatment: hydration, antipyretic, decongestion, etc.
  • Check to make sure there is no stridor at rest (sign of moderate or severe croup = hospitalisation)
  • Give one dose of dexamethasone or, if unavailable, prednisolone PO
  • Monitor for 1 hour to confirm improvement.
• Purulent conjunctivitis (no corneal lesions):
  • Clean the eyes with clean water 
    + tetracycline 1% eye ointment for 7 days
• Bitot’s spot (no corneal lesions):
  • Vitamin A (retinol) PO: one dose on D1 and D2 and a third dose 4 to 6 weeks later aCitation a.If, for practical reasons, this 4- to 6-week time frame is difficult to maintain, the third dose can be given on D8. For pregnant women (ask the patient), it is better to give a lower dose, i.e., 25,000 IU per week for 4 weeks.
• Uncomplicated watery diarrhoea (no dehydration):
  • Oral rehydration solution (ORS) according to WHO Plan A (See Appendix 14)
• Minor oral candidiasis (does not interfere with eating): nystatin PO for 7 days.

5.3.3 Starting treatment

For dosage by weight and age, see Appendix 13.