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Antibiotics may be Beneficial in Moderate Cholera

by Dr. Simi Paknikar on  January 15, 2011 at 8:24 AM Health In Focus   - G J E 4
Cholera is a diarrheal disease caused due to intake of food or water contaminated with a bacterium called Vibrio cholerae. It spreads as epidemics in places of poor sanitation and overcrowding. It causes watery diarrhea, which could be severe and lead to dehydration and death if not treated.
 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

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We must take these recommendations and suggestions using a pinch of salt because, [1] its always difficult to clinically diagnose dehydration as 5%,10% or more based on clinical examination. (2) These are not new antibiotics but the one used in the last 20-30 years. Advising to wait for patient to stop vomiting before commencing treatment is difficult as any patient with ten or more percent dehydration is likely to be very ill. No doctor living on earth will wait to institute treatment. The only fact which we must give importance is to emphasis on using the correct dose based on body surface area or weight. These bacteria cause more harm when the dose of antibiotic is low because the antibiotic will kill good bacteria and these bad ones will develop resistance fast and make the patient chronic carrier. The main problem of giving adequate dose as this will increase the cost of care and also side effects which is often difficult to tolerate.
Medifix Sunday, January 16, 2011

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