5.3 Treatment of uncomplicated cases


Standard treatment aimed at treating the fever and preventing the most common complications.
Added to this standard treatment is the treatment for minor complications found on clinical examination (Appendix 13).

Standard treatment

− Antipyretic: paracetamol PO
− Antibiotherapy: amoxicillin PO for 5 days (children < 5 years)
− Vitamin A: retinol PO on D1
− Cleaning the eyes with clean water
− Decongestion of the nasopharynx
− Hydration; caloric feeding, divided meals (every 2 to 3 hours) or more frequent breastfeeding
Depending on the context, nutritional supplements for children < 3 or 5 years

AND

Treatment for minor complications

Pneumonia with no severity criteria or acute otitis media: amoxicillin PO for 5 days

– Purulent conjunctivitis (no corneal lesions):
Cleaning the eyes with clean water
+ tetracycline 1% eye ointment for 7 days

– Bitot’s spot (no corneal lesions):
retinol PO: one dose on D1, D2 and D8

– Uncomplicated watery diarrhoea (no dehydration):
Oral rehydration solution (ORS) according to WHO Plan A (Appendix 14)

– Minor oral candidiasis (does not interfere with eating): nystatin PO for 7 days1

See Appendix 13 for doses according to weight or age.

5.3.1 Treatment

See also the guide: Treating measles in children. World Health Organization. WHO/EPI/TRAM/97.02 (updated 2004).
http://www.who.int/immunization_delivery/interventions/TreatingMeaslesENG300.pdf

Paracetamol is administered orally (oral solution or tablets, depending on age), in 3 to 4 divided doses over 24 hours for 2 to 3 days.

Five-day antibiotherapy (amoxicillin PO, except if resistance is known in the area) is given as a preventive measure to children under age 5 years. There are fewer complications (pneumonia and conjunctivitis) over the course of the illness, and better weight gain after the illness, in children on antibiotics23. If a child under 5 years has non-severe pneumonia or acute otitis media, there is no change in therapy since the first-line treatment for these infections is the same as the standard antibiotic therapy already routinely administered.

Clearing the 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 lavages with 0.9% sodium chloride solution may be useful in the event of significant nasal discharge (Appendix 15).

All patients receive a single dose of retinol (vitamin A)2 except:
– pregnant women (ask the patient);
– patients with Bitot’s spots: these patients receive a curative 3-dose treatment.

When appropriate to the situation, children under 3 or 5 years receive ready-to-use food (500 kcal daily) for 2 weeks.

Start treatment during the consultation:
– administer the first dose of paracetamol, retinol, amoxicillin in children < 5 years;
– in the event of diarrhoea, start ORS; apply the first dose of tetracycline, nystatin, etc. depending on the complications identified.
Provide the necessary supplies (drugs, cotton, and supplements) to continue treatment at home.

5.3.2 Advice to parents

1) Ask parents to:
− make the child drink, and give smaller, more frequent meals or breastfeed more frequently;
− keep his eyes clean, blow his nose frequently.

2) Instruct parents on how to use the medications (including how to prepare the ORS, if applicable) and nutritional supplements. Make sure they understand the instructions.

3) Ask them to bring the child back in if his condition worsens; for example, if he cannot drink or nurse, or is vomiting, if his consciousness is impaired (he is difficult to awaken), he has respiratory problems, or the diarrhoea worsens.

4) Explain that after measles, complications can still occur and that they should bring the child back in right away if he does not recover completely.

If in doubt (e.g., with high fever or copious diarrhoea), keep the child under observation for 2 hours or more to assess the response to treatment (e.g., fever reduction) and make sure that he will be able to follow the treatment at home (e.g., that he can drink the ORS).



Footnotes
Ref Notes
1 If nystatin is not available, gentian violet 0.25% may be applied 2 times daily for maximum of 5 days.
2 The usual recommendation is to administer 2 doses of retinol (one on D1 and one on D2) to all measles patients. However in an epidemic context, the administration of only one dose on D1 to uncomplicated cases facilitates home care.