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Comparison of single-dose azithromycin and 12-dose, 3-day erythromycin for childhood cholera: a randomised,
Wasif A Khan1, Debasish Saha, Anisur Rahman
1Clinical Sciences Division, International Centre For Diarrhoeal Disease Research, Bangladesh, Dhaka. wakhan@icddrb.org
Insights
Single-dose azithromycin is as effective as erythromycin for treating childhood cholera, leading to shorter diarrhea duration and less vomiting. This finding offers a valuable treatment option for pediatric cholera cases.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Therapy
- Gastroenterology
Background:
- Cholera poses a significant public health challenge, disproportionately affecting children.
- Effective single-dose antimicrobial treatments for pediatric cholera are limited.
- This study addresses the need for optimized treatment regimens in children.
Purpose of the Study:
- To compare the efficacy of single-dose azithromycin versus erythromycin in treating cholera in children.
- To evaluate clinical and bacteriological success rates for both treatment groups.
- To assess secondary outcomes such as duration of diarrhea and vomiting episodes.
Main Methods:
- A double-blind, randomized study involving 128 severely dehydrated children (ages 1-15) with cholera in Bangladesh.
- Participants received either single-dose azithromycin (20 mg/kg) or erythromycin (12.5 mg/kg every 6 hours for 3 days).
- Clinical success (diarrhea cessation within 48 hours) and bacteriological success (Vibrio cholerae eradication) were primary outcomes.
Main Results:
- Clinical success rates were 76% for azithromycin and 65% for erythromycin.
- Bacteriological success rates were 71% for azithromycin and 82% for erythromycin.
- Azithromycin treatment resulted in a significantly shorter duration of diarrhea (median 24h vs 42h) and fewer vomiting episodes.
Conclusions:
- Single-dose azithromycin demonstrates comparable clinical efficacy to standard erythromycin therapy for pediatric cholera.
- Azithromycin is associated with a significant reduction in vomiting episodes compared to erythromycin.
- Azithromycin offers a favorable treatment option for children with cholera, improving patient comfort and potentially reducing hospital stay duration.
Background:
Cholera is a major public-health problem, with children most affected. However, effective single-dose antimicrobial regimens have been identified only for adults. Our aim was to compare the efficacy of azithromycin and erythromycin regimens in the treatment of children.
Methods:
We did a double-blind, randomised study of 128 severely dehydrated children (age 1-15 years) with cholera, treated at one of two treatment centres in Bangladesh in 1999. Children were assigned single-dose azithromycin (20 mg/kg bodyweight, maximum individual dose 1 g; n=65) or 12.5 mg/kg erythromycin (maximum dose 500 mg; n=63) every 6 h for 3 days. Patients stayed in hospital for 5 days. We measured fluid balance every 6 h, and obtained a rectal swab or stool sample for culture daily. Our primary outcome measures were clinical success of treatment-ie, cessation of watery diarrhoea within 48 h-and bacteriological success-ie, absence of Vibrio cholerae O1 or O139 from cultures of stool or rectal swab samples after study day 2. Analysis was per protocol.
Findings:
Two children in both groups withdrew from the study, and we excluded one child in the erythromycin group. Treatment was clinically successful in 48 (76%) patients who received azithromycin and 39 (65%) who received erythromycin (difference 11%, 95% CI -5 to 27, p=0.244); and bacteriologically successful in 45 (71%) and 49 (82%) patients, respectively (10%, -5 to 25, p=0.261). Patients treated with azithromycin had a shorter duration of diarrhoea (median 24 h vs 42 h; difference 12 h, 0-18 h, p=0.019) and fewer episodes of vomiting (1 vs 4; difference 1 episode, 0-3 episodes, p=0.023).
Interpretation:
Single-dose azithromycin is as effective for treatment of cholera in children as standard erythromycin therapy, but is associated with less vomiting.
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