Cholera is a major public-health problem which is greatly under-reported.
Children are most affected by this bacterial disease which causes severe diarrhoea, resulting in dehydration.
Around 5000 deaths from cholera were reported to the WHO in 2000.
|Cost may be the real issue affecting future drug treatment of childhood cholera.|
This is probably a severe underestimate as Bangladesh - where over 200,000 people are infected with the cholera bacterium - has not supplied WHO with data relating to cholera illness or death.
Effective single-dose antibiotics have only been identified for adults with cholera.
However, single-dose regimens are especially desirable for children to increase compliance.
Mr Wasif Khan from the Centre for Health and Population Research, Dhaka, Bangladesh, and colleagues, performed a randomized study of 128 severely dehydrated children with cholera, treated at 1 of 2 treatment centers in Bangladesh in 1999.
Children were assigned either single-dose azithromycin (20 mg/kg bodyweight), or 12·5 mg/kg erythromycin every 6 hours for 3 days.
The researchers found that although treatment success was similar in both groups, children given azithromycin had reduced duration of diarrhoea, compared with those given erythromycin.
Furthermore, vomiting was also reduced in children given azithromycin (1 case compared with 4 cases in the erythromycin group).
The investigators comment how cost may be the real issue affecting future drug treatment of childhood cholera. Azithromycin is 5 times more expensive than co-trimoxazole, and 50% more expensive than erythromycin.
Mr Khan concludes, "Whether or not the potential advantages of single-dose azithromycin-increased compliance, simplified logistics, reduction in vomiting-justify the additional cost when compared with other drug regimens is a decision that individual treatment centers involved in the care of children with cholera will have to make."