Study reviews antimicrobial drug effects on cholera treatment

An independent review of the effects of using antimicrobial drugs to treat cholera was published on Thursday in The Cochrane Library.

The work was done by researchers from the Cochrane Infectious Diseases Group and coordinated by the Liverpool School of Tropical Medicine's editorial base.

The review conducted 39 randomized and quasi-randomized controlled clinical trials using 4,623 adults and children. The antimicrobial therapy was shown to shorten the duration of diarrhea by approximately a day and half.

Total stool volume was also reduced by 50 percent using antimicrobial therapy. The amount of required rehydration fluids also decreased by 40 percent.

The researchers found no clear difference in stool volume or diarrhea duration when comparing tetracycline to doxycycline, ciprofloxacin or norfloxacin. There was an indirect comparison, however, that showed larger benefits from tetracycline compared with doxycycline, norfloxacin and trimethoprim-sulfamethoxazole.

Additionally, diarrhea duration was decreased by more than a day with a single dose of azithromycin when compared with ciprofloxacin. When compared with erythromycin, the duration was shortened by half a day.

"In treating cholera a quick and accurate diagnosis remains key, but it is clear from the results that antimicrobials result in substantial improvements in clinical and microbiological outcomes, with similar effects observed in severely and non-severely ill patients," Ya'ara Leibovici-Weissman, from Tel Aviv University, said. "Our results also point to the likelihood that azithromycin and tetracycline may have some advantages over other antibiotics."

Cholera is caused by a Vibrio cholerae bacterial infection and results in acute watery diarrhea, leading to rapid dehydration and death.