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Antibiotic therapy of cholera in children
Insights
Tetracycline is the most effective oral antibiotic for treating cholera in children, significantly reducing symptoms and fluid needs. While 48-hour oral therapy is clinically effective, longer durations may be needed to prevent relapses.
Area of Science:
- Infectious Diseases
- Pediatrics
- Pharmacology
Background:
- Cholera remains a significant cause of diarrheal disease in children.
- Effective antibiotic treatment is crucial for managing cholera and reducing transmission.
Purpose of the Study:
- To compare the efficacy of four oral antibiotics in treating cholera in children.
- To determine optimal duration and dosage of tetracycline therapy for cholera.
Main Methods:
- A controlled trial involving children with cholera in Dacca, East Pakistan.
- Evaluation of tetracycline, chloramphenicol, streptomycin, and paromomycin.
- Assessment of clinical outcomes (stool volume, fluid requirement, diarrhea duration) and microbiological outcomes (positive stool culture).
Main Results:
- Tetracycline demonstrated superior efficacy compared to other antibiotics and intravenous fluid therapy alone.
- Increasing tetracycline duration or dose shortened positive culture duration but did not improve stool volume or diarrhea duration.
- Chloramphenicol was effective but inferior to tetracycline; streptomycin and paromomycin showed minimal benefit.
Conclusions:
- Tetracycline is the preferred oral antibiotic for treating Vibrio cholerae infections in children.
- 48-hour oral tetracycline therapy is clinically effective but associated with a 20% relapse rate.
- Further research is needed to determine if extended therapy can eliminate relapses.
Abstract:
In a controlled trial of the effects of oral antibiotics in treating cholera in children in Dacca, East Pakistan, tetracycline was the most effective of 4 antibiotics tested in reducing stool volume, intravenous fluid requirement, and the duration of diarrhoea and positive stool culture. Increasing the duration of tetracycline therapy from 2 to 4 days, or increasing the total dose administered, resulted in shorter duration of positive culture, but did not affect stool volume or duration of diarrhoea. Only 1% of the children receiving tetracycline had diarrhoea for more than 4 days. Tetracycline was significantly more effective than intravenous fluid therapy alone, regardless of severity of disease.Chloramphenicol, while also effective, was inferior to tetracycline. Streptomycin and paromomycin exerted little or no effect on the course of illness or duration of positive culture. Therapeutic failures with these drugs were not due to the development of bacterial resistance.From these findings, tetracycline appears to be the drug of choice against Vibrio cholerae infection in children. Oral therapy for 48 hours is effective clinically, but is associated with 20% bacteriological relapses when the drug is discontinued; it is not known whether extending the therapy for a week or more would eliminate such relapses.