Single-dose azithromycin is effective in the treatment of severe cholera in children, but its effectiveness in adults has not been evaluated.
Dr Debasish Saha and colleagues conducted a double-blind, randomized trial comparing the equivalence of azithromycin and ciprofloxacin.
The investigative team assessed 195 men with severe cholera caused by Vibrio cholerae O1 or O139.
The participants were each given a single 1-g dose of 2 500-mg tablets.
The team reported that 97 patients received azithromycin and 98 patients received ciprofloxacin.
Patients were hospitalized for 5 days, and a stool culture was performed daily.
The investigators' primary outcome measures were clinical and bacteriologic success.
|Therapy was clinically successful in 73% with azithromycin|
|New England Journal of Medicine|
Clinical success was defined as cessation of watery stools within 48 hours after drug administration, and bacteriological success was the inability to isolate V cholerae after 48 hours.
The team noted that therapy was clinically successful in 73% of patients receiving azithromycin, and in 27% of patients receiving ciprofloxacin.
Therapy was bacteriologically successful in 78% of patients receiving azithromycin, and in 10% of patients receiving ciprofloxacin.
Patients who were treated with azithromycin had a shorter duration of diarrhea than did patients treated with ciprofloxacin, of 30 hours vs 78 hours, respectively.
The investigators found that patients with azithromycin had a lower frequency of vomiting, fewer stools, and a lower stool volume.
The team observed that the median minimal inhibitory concentration of ciprofloxacin for the 177 isolates of V cholerae O1 was 0.25 µg per milliliter.
This was 11 to 83 times as high as that in previous studies at this site.
Dr Saha's team concluded, “Single-dose azithromycin was effective in the treatment of severe cholera in adults.”
“The lack of efficacy of ciprofloxacin may result from its diminished activity against V cholerae O1 strains currently circulating in Bangladesh.”