Efficacy of erythromycin, ampicillin, and tetracycline in the treatment of cholera in children

Abstract

Objectives: Compare the clinical outcome(s) of treatment of cholera in children with ampicillin, erythromycin, and tetracycline. Methodology: In a double-blind randomized 4-cell trial, 184 children aged 1-5 years whose weight-for-age was more than 80% of the NCHS standard were given either tetracycline, erythromycin, ampicillin, or placebo for 3 days (the dosage suggested by the World Health Organization) in a diarrhoeal disease hospital in Dhaka. Selection criteria included diarrhoea of less than 48 hours duration, signs of some or severe dehydration, a dark-field stool microscopy demonstrating the presence of Vibrio cholerae and baseline purging rate more than 4 mL.kg/h (over 6 hours). Results: After three days of antibiotic treatment, the mean±SEM stool output was significantly reduced in each of the three groups who received antibiotics compared to the placebo group. The mean duration of recovery was 66% longer in the placebo group (p=0.000), 25% in the ampicillin group (p=0.017), and 9% in the erythromycin group (p=0.37) compared to the tetracycline group. The clinical recovery rate by 96 hours was 75% (p=0.001) in the placebo group, 91.3% in the ampicillin group (p=0.16), and 95.7% in the erythromycin group (p=0.04) compared to the tetracycline group. The stool output in mL.kg.body weight was: 318±50, 335±3O, 323±25, and 498±37 respectively in tetracycline, ampicillin, erythromycin, and placebo groups. Conclusion: The results of the study indicate that the clinical efficacy of tetracycline, ampicillin, and erythromycin in the treatment of cholera in children was comparable. It is recommended that, where test for V cholerae is positive to ampicillin, it can be used as an effective alternative antibiotic for the treatment of cholera and acute respiratory tract infections