Single drug dose may be better against cholera

A single dose of the antibiotic ciprofloxacin cures cholera in children as often as a 12-dose regimen of erythromycin does, a comparison of the treatments has revealed.

Severe diarrhea from the disease can cause life-threatening dehydration in children. Standard therapy for infected children is a 3-day course of erythromycin or tetracycline. But these regimens often pose logistical problems in developing countries, says Debasish Saha, a clinician and epidemiologist at the Centre for Health and Population Research in Dhaka, Bangladesh.

Saha’s team randomly assigned 162 cholera patients, ages 2 to 15, to receive either a single dose of ciprofloxacin powder dissolved in water or 12 erythromycin doses spaced equally over 3 days. The patients were then kept in a hospital for 5 days for observation.

The researchers report in the Sept. 24 Lancet that the cure rate in both groups was roughly equal: The severe diarrhea stopped in 60 percent of children getting ciprofloxacin and in 55 percent of those getting erythromycin.

Children getting ciprofloxacin also had less vomiting during their hospital stays. Therefore, Saha says, fluid could be replaced by mouth, reducing the need for expensive intravenous infusions.

Analysis of the children’s stools on the third day of each patient’s hospital stay and during a follow-up visit 2 to 6 weeks later showed that ciprofloxacin didn’t clear the cholera-causing bacterium, Vibrio cholerae, from the patients as well as erythromycin did. Cholera typically spreads via contamination of drinking water with fecal matter.

Saha’s team had reported previously that single-dose azithromycin could stop cholera in children. Because of growing resistance of V. cholerae to antibiotics, doctors welcome additions to their antibiotic armamentarium, Saha says.