ArticlesRandomised controlled comparison of single-dose ciprofloxacin and doxycycline for cholera caused by Vibrio cholerae O1 or O139
Introduction
Cholera continues to be a major, worldwide public-health problem; more countries reported cases of Vibrio cholerae infection to WHO in 1994 than in any previous year.1 Antimicrobial treatment of V cholerae O1 infections can reduce the duration and volume of diarrhoea by half2, 3 and, thus, is an important adjunct to fluid replacement in the treatment of cholera.2, 3, 4 However, the efficacy of available antimicrobial agents has been reduced by the emergence of multiresistant strains of V cholerae O1 in Africa, Asia, and Latin America.5, 6 A cholera outbreak among Rwandan refugees in 1994 caused by such a strain resulted in more than 20 000 deaths.7
Fluroquinolone agents are commonly used in the treatment of enteric infections, because of their good in-vitro activity, the high serum and stool concentrations achieved after ingestion, and their safety.8 There have, however, been few studies of the efficacy of quinolones in cholera,9, 10, 11 and with one exception,10 the studies that have been done have been small and lacked power to detect differences in the comparison treatment. In addition, the efficacy of single-dose quinolones has not been assessed. Similarly, the efficacy of antimicrobial agents in the treatment of cholera caused by the newly identified Vcholerae O139, has not been systematically investigated.
Because of its in-vitro activity against multiresistant strains of V cholerae O1 and O139, its high concentration in the interstinal lumen, and long half-life, ciprofloxacin was a logical candidate to evaluate for single-dose therapy of cholera. In this study we compared single-dose ciprofloxacin with single-dose doxycycline treatment of patients with cholera caused by Vcholerae O1 or O139.
Section snippets
Methods
We recruited patients between April, 1993, and February, 1995, at two diarrhoea treatment centres maintained by the International Centre for Diarrhoeal Disease Research, Bangladesh-one in the capital, Dhaka, and the other in the rural district of Matlab. Eligible patients were men, aged 18–60 years, who had had watery diarrhoea for 24 h or less, and who were moderately or severely dehydrated.6 Patients who had a concomitant illness or had received antimicrobial treatment for this illness were
Results
We enrolled 272 patients. 12 patients (six ciprofloxacin, six doxycycline) were excluded from analysis: ten withdrew before completion of treatment, and two were transferred to other hospitals. 130 patients infected with V cholerae O1 (66 ciprofloxacin, 64 doxycycline), and 130 patients infected with V cholerae O139 (59 ciprofloxacin, 71 doxycycline) were included in the analysis.
The treatment groups were well matched in terms of pretreatment characteristics (table 1).
Among patients infected
Discussion
We found a higher rate of bacteriological cure with ciprofloxacin than with doxycycline among patients infected with V cholerae O1 or O139, but a higher rate of clinical cure only among O1-infected patients. The higher rate of bacteriological success in ciprofloxacin-treated patients is probably attributable to the high stool concentrations of ciprofloxacin relative to the concentration of drug required to inhibit growth of the infecting strain of V cholerae. V cholerae was cleared from the
References (25)
- et al.
Tetracycline in the treatment of cholera
Lancet
(1964) Diarrhoeal disease: current concepts and future challenges: antimicrobial therapy and prophylaxis
Trans R Soc Trop Med Hyg
(1993)- et al.
Comparative trial of five antimicrobial compounds in the treatment of cholera in adults
Trans R Soc Trop Med Hyg
(1995) - et al.
Therapy for shigellosis: 1. Randomized, double-blind trial of nalidixic acid in childhood shigellosis
J Pediatr
(1988) - et al.
Sensitive and selective determination of picogram amounts of ciprofloxacin and its metabolites in biological samples using high-performance liquid chromatography and photothermal post-column derivatization
J Chromatogr
(1987) - et al.
Hospital outbreaks of cholera transmitted through close person-to-person contact
Lancet
(1984) Cholera in 1944: part 1
Wkly Epidemiol Rec
(1995)Cholera: pathophysiology, clinical features, and treatment
Guildelines for cholera control
(1991)- et al.
Antimicrobial resistance of enteric pathogens
Survey of in vitro susceptibilities of Vibrio cholerae O1 and O139 to antimicrobial agents
Antimicrob Agents Chemother
Public health impact of Rwandan refugee crisis: what happened in Goma, Zaire, in July, 1994?
Lancet
Cited by (84)
Antimicrobial Treatments of Infectious Diarrhea
2022, Comprehensive PharmacologyEmergence of Haitian variant genotype and altered drug susceptibility in Vibrio cholerae O1 El Tor-associated cholera outbreaks in Solapur, India
2020, International Journal of Antimicrobial AgentsCitation Excerpt :Effective and optimal use of antibiotics to control diarrhoeal infection is urgently required for the management of antimicrobial resistance. Ciprofloxacin is reported to be better than doxycycline for the treatment and eradication of V. cholerae from stools and reduces secondary cholera cases [18]. There may be a delay in or failure of treatment owing to resistance (or reduced susceptibility) to tetracycline and ciprofloxacin [3,19].
Cholera and other Vibrio strain infections
2018, Medicine (Spain)Vibrio cholerae (Cholera)
2018, Principles and Practice of Pediatric Infectious DiseasesJAID/JSC Guidelines for Infection Treatment 2015−Intestinal infections
2018, Journal of Infection and ChemotherapyQuinolones
2017, Infectious Diseases, 2-Volume Set