Efficacy of azithromycin in severe cholera in adults

A single dose of azithromycin is effective in the treatment of severe cholera in children, but the efficacy of this therapy in adults has remained unproven until recently. In a study of 195 adult men with severe cholera caused by Vibrio cholerae O1 or O139, they were treated with ciprofloxacin, each of which was prescribed once at a dose of 1 g (2 tablets of 500 mg). The patients were hospitalized for 5 days. A daily faecal culture test was performed. Clinical efficacy was defined as stopping watery diarrhea within 48 hours of drug administration, and bacteriological efficacy was defined as stopping excretion of V. choraraewith feces within 48 hours.

Clinical efficacy was observed in 71 (73%) of the 97 patients who received azithromycin and in 26 (27%) of the 98 patients who were prescribed ciprofloxacin (p less than 0.001). Bacteriological efficacy was observed in 76 (78%) of 97 and 10 (10%) of 98 patients in each group, respectively (p less than 0.001). In patients receiving azithromycin, compared to the ciprofloxacin group, the duration of diarrhea was shorter (30 versus 78 hours), vomiting was seen in a smaller number of patients (43% versus 67%), the number of stools was lower (an average of 36 versus 52), and the amount of feces was also lower (an average of 114 versus 322 ml / kg of body weight). For 177 strains isolated from V. cholerae O1, the mean minimum inhibitory concentration of ciprofloxacin was 0.25 mg / ml. This indicator was 11 to 83 times higher than for previously isolated crops.

Thus, a single dose of azithromycin is effective in the treatment of severe cholera in adults. The low observed efficacy of ciprofloxacin may be due to the low activity of the drug against the strains of V. choolerae O1 currently in circulation in Bangladesh.