Furazolidone and tetracycline (together with routine fluid and electrolyte replacement) were equally effective in reducing the duration of diarrhoea, vibrio excretion, and intravenous-fluid administration requiring close observation in cases of cholera. Furazolidone 400 mg. in a single dose was as effective as 100 mg. six-hourly, and no untoward effects were noted. For public-health purposes, the single-dose regimen and low cost of furazolidone are advantages.

The objective of this article is to report the experience of a cholera outbreak causing more than two thousand deaths in 2006 in Angola. I describe my observations and feelings, as well as some of the interventions performed by the team of the organization Médecins du Monde, aimed at contributing to control the outbreak. This report is a real example of how some populations are still vulnerable to easily preventable diseases

Resumen Introducción. El cólera es una enfermedad infecciosa de comportamiento epidémico, que sigue amenazando la salud pública. En 2010 estalló un brote en Haití cuya letalidad inicial fue de 6,4%, posiblemente por falta de conocimientos del personal médico sobre su manejo. La letalidad se estabilizó alrededor del 1%, pero existe el riesgo que la epidemia llegue a Colombia y haya médicos sin adecuado conocimiento para su intervención. Objetivo. Determinar el nivel de conocimientos sobre el cólera que tienen los estudiantes de Medicina de una universidad en Colombia. Materiales y métodos. Estudio observacional de corte transversal. Previo consentimiento informado, se aplicó una encuesta sobre conocimientos del cólera a estudiantes de Medicina que ya habían aprobado los cursos de ciencias básicas, infecciosas y epidemiología. Resultados. Participaron 323 estudiantes, con promedio de edad de 22 años, 50,8% hombres. Los niveles de conocimiento fueron independientes de edad y sexo, pero aumentan con el nivel académico (p=0,031). Los conocimientos sobre signos clínicos, vía de transmisión y población vulnerable, fueron acertados por más del 90% de los participantes; mientras que saberes sobre configuración del brote, uso de antibióticos y comportamiento reciente del cólera, fueron respondidos adecuadamente por menos del 23% de ellos. Conclusión. Los estudiantes de Medicina tienen conocimientos insuficientes para garantizar un adecuado manejo de un brote de cólera, sobre todo en lo concerniente al uso de antibióticos y la prevención de la trasmisión de la enfermedad.

From May 1964 to December 1965, a controlled field trial of the effectiveness of cholera and cholera El Tor vaccines was conducted in Negros Occidental, Philippines. Some people did not volunteer for vaccination, and of those who did some received cholera vaccine and others a control (typhoid) vaccine. After analysing he incidence of cholera among these three groups it was found that the morbidity and mortality rates were significantly higher in the unvaccinated group than in either the control vaccine group or the cholera vaccine group. This would indicate that the unvaccinated group is basically different from the vaccinated control group. The clinical course of the disease was the same whether the patient had been vaccinated or not. The reasons for non-vaccination were investigated and should be taken into account by public health agencies when immunization programmes are being planned.

In past studies, patients with cholera and cholera-like diarrhoea treated with rice oral rehydration solution (ORS) had lower purging rates and a shorter illness duration. We evaluated a new packet form of rice ORS (CeraLyte-90) in 167 boys aged 5 to 15 y, with acute, dehydrating cholera and cholera-like diarrhoea in Bangladesh. The patients were randomized to receive either CeraLyte-90 (n = 85) or glucose ORS (n = 82) and were given early feeding and early antibiotics. The efficacy of the two solutions was compared for stool output during the first 8 h, the first 24 h, and total output, duration of diarrhoea, hematocrit, serum electrolytes and requirement for unscheduled intravenous fluids. The clinical and laboratory characteristics of the two groups were comparable on admission, and most of the patients had cholera (88% and 84% in the CeraLyte and glucose groups, respectively). The mean (+/- SE) stool output was 20% less in the rice ORS group during the first 8 h of treatment (86.2+/-6.6 ml/Kg vs 108.8+/-7.9 ml/Kg, p < 0.05), but the outputs during the other time periods were similar in the two groups, although children in the rice ORS group had slightly more vomiting on day one (p < 0.05). The mean serum electrolyte concentrations in both groups of children remained within normal range.

CONCLUSION:

The study documents the safety and efficacy of the new, packaged rice ORS.

Recent clinical trials having established the value of tetracycline as an adjunct to fluid and electrolyte replacement in cholera treatment, a controlled trial of antibiotic therapy was conducted in Dacca on 318 adults hospitalized for cholera. The effects of 4 antibiotics orally administered in varying dosage schedules were studied.Cholera therapy with tetracycline or chloramphenicol caused a highly significant reduction in the duration of diarrhoea and of positive culture, in stool volume, and in intravenous fluid requirement as compared with the results in controls who received intravenous fluid therapy only. Streptomycin was also effective, but to a lesser degree; paromomycin was of little value.The severity of dehydration on admission was significantly related to subsequent duration of diarrhoea regardless of whether antibiotics were given. Increasing age was associated with more prolonged purging in patients receiving antibiotics.Increasing the dose of tetracycline to 2 to 3 times that usually administered, or prolonging treatment from 2 to 4 days, did not enhance the therapeutic results. The effect of tetracycline was apparent within a few hours of administration. Bacteriological relapses were seen after discontinuation of therapy in all treatment groups, but were not due to the development of resistant bacteria.

Doxycycline was compared with tetracycline in the treatment of cholera. Four types of treatment were compared: Group A was given 200 mg of doxycycline on admission and 100 mg on the second day; Group B was given 200 mg of doxycycline on admission only; Group C was given 300 mg of doxycycline on admission only; and Group D received 500 mg of tetracycline every 6 h for 48 h. Tetracycline showed a slight advantage in respect of duration of diarrhoea and vibrio excretion compared with doxycycline given as a single dose of 300 mg, but fluid intake and output were about the same in these two groups. The other two doxycycline treatment schedules did not compare well with tetracycline treatment.

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Background: Young children are one of the most vulnerable groups who may be infected with cholera. The following literature review of the efficacy of the currently available cholera vaccines provides a clear evidence base for the clinical administration of cholera vaccine, particularly in an epidemic situation. Aim: To assess the efficacy of oral cholera vaccines in preventing cases of cholera in young children. Methods: A systematic literature review was undertaken for the period 1983 to 2011 using PubMed and the search terms "oral cholera vaccines," "children," and "efficacy," limited to "clinical trials" and "human studies". Results: Oral cholera vaccine provides an acceptable level of protection in young children, with the level of protection being greater at 12 or 24 months following immunization. Conclusions: Children exposed to a potential risk of cholera are recommended to be vaccinated with an oral cholera vaccine, irrespective of whether its constituents include the B subunit, © 2011 Masuet Aumatell et al.

AIM:

To evaluate the efficacy of azithromycin in the treatment of cholera in children.

METHODS:

A double-blind, randomized, controlled clinical trial on 80 children with acute watery diarrhoea and moderate to severe dehydration compared the efficacy of azithromycin and erythromycin in treating cholera. Data were analysed for 56 patients who were stool culture positive for Vibrio cholerae. In conjunction with rehydration therapy, 29 patients received azithromycin and 27 patients received erythromycin. Patients in the two treatment groups had comparable clinical and blood biochemical characteristics on admission.

RESULTS:

Patients who received azithromycin had significantly less stool output, shorter duration of diarrhoea and lower fluid intake compared with patients who received erythromycin.

CONCLUSION:

Azithromycin appears to be superior to erythromycin for treating cholera in children.