What is the treatment for a patient with measles and tonsillopharyngitis?

Treatment of Measles with Tonsillopharyngitis

Measles requires supportive care with vitamin A supplementation, while concurrent bacterial tonsillopharyngitis (if confirmed by testing) should be treated with appropriate antibiotics, but measles itself has no specific antiviral therapy. 1

Immediate Infection Control Measures

• Place the patient in airborne isolation immediately using a negative air-pressure room, or if unavailable, a private room with the door closed and have the patient wear a mask 1
• All healthcare personnel entering the room must use N95 respirators or equivalent respiratory protection, regardless of immunity status 1
• Exclude the patient from work/school until ≥4 days following rash onset 1

Supportive Treatment for Measles

Vitamin A supplementation is essential and reduces mortality:

• Children with clinical measles should receive 200,000 IU vitamin A orally (100,000 IU if <12 months of age) 1
• Repeat vitamin A on day 2 if the patient has complicated measles (pneumonia, otitis, croup, diarrhea with moderate/severe dehydration, or neurological problems) 1
• If eye symptoms of vitamin A deficiency are present (xerosis, Bitot's spots, keratomalacia, corneal ulceration), give 200,000 IU on days 1,2, and again 1-4 weeks later 1

Additional supportive measures:

• Monitor nutritional status and enroll in feeding programs if indicated 1
• Provide oral rehydration therapy for diarrhea 1
• Treat fever with acetaminophen or NSAIDs (avoid aspirin in children) 1
• There is no specific antiviral treatment for measles 2, 3

Management of Concurrent Tonsillopharyngitis

Only treat bacterial tonsillopharyngitis if confirmed by testing:

• Perform rapid antigen detection testing (RADT) and/or throat culture for Group A Streptococcus before prescribing antibiotics 4, 5
• Fever, respiratory tract infection, and diarrhea are not contraindications for measles vaccination or treatment 1

If Group A Streptococcus is confirmed:

• First-line treatment: Penicillin V oral for 10 days (children: 250 mg 2-3 times daily; adolescents/adults: 250 mg four times daily or 500 mg twice daily) 1, 4
• Alternative first-line: Amoxicillin 50 mg/kg once daily (maximum 1,000 mg) for 10 days 1, 4

For penicillin-allergic patients:

• Non-anaphylactic allergy: First-generation cephalosporins (cephalexin 20 mg/kg/dose twice daily, maximum 500 mg/dose) for 10 days 1, 4
• Anaphylactic allergy: Clindamycin (7 mg/kg/dose three times daily, maximum 300 mg/dose) for 10 days, or azithromycin (12 mg/kg once daily, maximum 500 mg) for 5 days 1, 4, 6

Treatment of Bacterial Complications

Treat secondary bacterial infections with appropriate antibiotics:

• Pneumonia: Antibiotics for acute lower respiratory infection 1
• Otitis media: Standard antibiotic therapy 1
• Monitor for and treat bacterial superinfections appropriately 3, 7

Important Caveats and Pitfalls

• Do not delay measles treatment waiting for laboratory confirmation - clinical suspicion should prompt immediate isolation and supportive care 8
• Undernutrition is NOT a contraindication for measles vaccination; it should be considered a strong indication 1
• Do not withhold vitamin A even if the patient received it within the previous month - repeat dosing is indicated for complicated measles 1
• Avoid unnecessary antibiotics - only treat confirmed bacterial infections, not the measles virus itself 4, 5
• Do not perform routine follow-up throat cultures for asymptomatic patients who completed appropriate antibiotic therapy for streptococcal pharyngitis 1, 4
• Isolation is not indicated in emergency camp settings for measles, but airborne precautions are mandatory in healthcare facilities 1

Post-Exposure Prophylaxis for Contacts

• Administer MMR vaccine within 72 hours of exposure to provide protection or modify disease 1
• For immunocompromised or pregnant contacts: Immune globulin 0.25 mL/kg (standard dose) or 0.5 mL/kg (immunocompromised) intramuscularly 1