Randomised controlled comparison of single-dose ciprofloxacin and doxycycline for cholera caused by Vibrio cholerae O1 or O139

Transferable Quinolone Resistance in Vibrio cholerae

“…Between 2003 and 2008, the median MIC of ciprofloxacin was 0.25 to 0.38 g/ml, without a change over this interval (Table 2). These values were, however, 100-fold and 10-fold higher than the median MICs of ciprofloxacin for isolates of V. cholerae from Bangladesh in 1996 and 2002, respectively (15,21). The maximum MIC, however, increased between 2003 and 2005 from 0.25 to 1.5 g/ml and then fell to 0.25 to 0.5 g/ml from 2006 to 2008.…”

“…From 1993 to 1995, the MICs of ciprofloxacin were 0.003 g/ml or less for all strains tested in one study that demonstrated 94% efficacy of a single 1-g dose of ciprofloxacin for treatment of cholera in adults (15). In 2001 and 2002, the MICs of ciprofloxacin were 10-fold higher (0.023 g/ml and 0.047 g/ml) and associated with 60% efficacy when a single dose of ciprofloxacin (20 mg/kg) was given to pediatric patients (21).…”

“…In addition to maintenance oral rehydration therapy, adjunctive antimicrobial therapy reduces the extent and duration of diarrhea, resulting in reduced fluid requirements and hospitalizations, reductions that are particularly important in resource-limited areas. Antimicrobial therapies have included tetracycline, azithromycin, and fluoroquinolones, such as ciprofloxacin, but the activity of fluoroquinolones has decreased in some areas, and this decreased activity has been associated with substantial reductions in the efficacy of ciprofloxacin relative to that of azithromycin (15,20). To evaluate the evolution of ciprofloxacin resistance in Vibrio cholerae, we studied isolates from Bangladesh available over a 6-year period in which poor clinical responses of cholera patients to ciprofloxacin were recognized.…”

Single-dose azithromycin for childhood cholera

“…Though the study design was almost consistently followed with the recent publication in Lancet and NEJM but the authors used different outcome variable (72 h instead of 48 h), that made it difficult to compare it with earlier studies (2)(3)(4)(5). Although, in the discussion, authors did state the discrepancies in using different criteria for the clinical and bacteriological success rates, among the references quoted, the success rate was based on 48 h definition in 4 out of 5 relevant trial articles.…”

Meddling Vibrio cholerae Murmurs: A Neoteric Advancement in Cholera Research

“…As defined by CDC (Center for Disease Control) doxycycline/tetracycline are given as a first line treatment in adults whereas azithromycin/erythromycin are given for children and pregnant women. Furazolidone, erythromycin, trimethoprim-Sulphamethoxazole, chloramphenicol, azithromycin, ciprofloxacin are preferred for adult administration [9][10][11][12]. The significant detriment of the antibiotic is that it will abbreviate the time of infection instead of counter-acting the disease.…”