Antibiotics may be Beneficial in Moderate Cholera
The WHO recommends oral rehydration solution as the first line of treatment in cholera. ORS helps to prevent and treat the dehydration and reduce the chances of death in patients with cholera. Patients with severe dehydration are treated with intravenous fluids so that the fluids are replaced faster. Antibiotics such as doxycycline, ciprofloxacin and azithromycin, tetracycline, furazolidone and trimethoprim - sulfamethoxazole are used in the treatment in cholera depending on the sensitivity of the organism. Antibiotics shorten the duration of illness as well as reduce the spread of the disease to other members of the community. The WHO currently recommends the use of antibiotics for severe cases only, that is, in patients with 10% or more than 10% dehydration.
Some researchers however, feel that the guidelines recommended by the International Center for Diarrheal Disease Research, Bangladesh are more appropriate for the treatment of cholera with antibiotics. These recommendations suggest the use of antibiotics for severe as well as moderate cases, that is, patients with 5 to 10 % dehydration, who pass large volumes of diarrheal stools during treatment and who suffer from typical cholera symptoms. Antibiotics are however not recommended to prevent infections in close contacts of patients, since such a practice could lead to the development of resistance. Since the patient may vomit out the antibiotic, researchers recommend that the antibiotics may be started after adequate rehydration is achieved and vomiting in the patient reduced.
Reference: Antibiotics for both moderate and severe cholera. N Engl J Med. 2011;364(1):5-7