COMPARATIVE TRIAL OF 5 ANTIMICROBIAL COMPOUNDS IN THE TREATMENT OF CHOLERA IN ADULTS

To compare the efficacy of ciprofloxacin, erythromycin, nalidixic acid and pivmecillinam in the treatment of tetracycline-resistant strains of Vibrio cholerae O1 in adults, a randomized, open, clinical trial wa s conducted. A tetracycline group was used for comparison. Seventy-fiv e adult men infected with V. cholerae O1 were randomly assigned to rec eive either 400 mg pivmecillinam or 500 mg of one of each of the other drugs. Ciprofloxacin was given every 12 h and the others every 6 h fo r 3 d. The mean total stool volume per kg was 155 mL for the ciproflox acin group, 212 mL for the erythromycin and pivmecillinam groups, 246 mL for nalidixic acid, and 293 mL for tetracycline. The difference bet ween ciprofloxacin and tetracycline was significant (P=0.045). After 7 2 h, diarrhoea had stopped in 14 patients (93%) in the ciprofloxacin g roup and 12 (80%) in the erythromycin group, compared to 5 (42%) of th ose receiving tetracycline (P=0.006 and 0.049, respectively). Bacterio logical clearance was 100% at 24 h in patients treated with ciprofloxa cin compared to 20% and 8.3% (P<0.001 for both comparisons) in the ery thromycin and tetracycline groups. Ciprofloxacin in conjunction with a ppropriate fluid therapy was the most effective treatment for cholera in adults; erythromycin was the next best.