Ciprofloxacin cholera

The cornerstone of cholera treatment is fluid replacement. Without treatment, the case-fatality rate for severe cholera is approximately 50%. For cholera, rice-based ORT is better than glucose-based ORT because it reduces the number of stools.21 Patients with significant disease should receive a short antibiotic course, 1 to 3 days, to shorten the duration of illness and decrease the number of stools. Doxycycline 300 mg once daily is the drug of choice. Other antibiotics shown to be effective include erythromycin, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin.2 Antibiotic resistance has been documented in V cholerae since 1977.2 Antibiotic prophylaxis is not warranted. 

Treatment — Because of the severe dehydration caused by cholera infection, the most important therapy is fluid and electrolyte replacement. Many antibiotics are effective against V. cholerae, including tetracycline, doxycycline, ciprofloxacin, and erythromycin.3... 

Vibrio cholerae. The cause of death in cholera is electrolyte and fluid loss in the stools and this may exceed 11/h. The most important aim of treatment is prompt replacement and maintenance of water and electrolytes with oral or intravenous electrolyte solutions. Doxycycline, given early, significantly reduces the amount and duration of diarrhoea and eliminates the organism from the faeces (thus lessening the contamination of the environment). Carriers may be treated by doxycycline by mouth in high dose for 3 days. Ciprofloxacin may be given for resistant organisms. 

Khan WA, Bennish ML, Seas C, et al. Randomized, controlled comparison of single-dose ciprofloxacin and doxycycline for cholera caused by Vbrio cholerae 01 or 0139. Lancet 1996 348 296-300... 

For large outbreaks, oral rehydration solutions (ORS) are useful. Standardised World Health Organization (WHO) ORS sachets are available although a home-made version can be produced by adding 8 level teaspoons of table sugar and 1 level teaspoon of table salt to 1 litre of water. Antibiotic therapy can be useful for cholera treatment but does not shorten the disease course. Doxycycline 300 mg p.o. as a stat dose, or ciprofloxacin 250 mg p.o. b.d. for 3 days is recommended. Cryptosporidium infections are self-limiting and effective treatment is strictly supportive. 

---